Provider Demographics
NPI:1750898672
Name:SAPP, KLISA REIJING
Entity type:Individual
Prefix:
First Name:KLISA
Middle Name:REIJING
Last Name:SAPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-6453
Mailing Address - Country:US
Mailing Address - Phone:813-451-7802
Mailing Address - Fax:
Practice Address - Street 1:1205 S TYLER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-6453
Practice Address - Country:US
Practice Address - Phone:813-451-7802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management