MEDICARE: PAULA KESSINGER PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA 20149	FL

General Provider Information

NPI Number	:	1275771289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA KESSINGER PTA

Provider Business Mailing Address
First Line	:	2725 ROBIE AVE
Second Line	:	SUITE 2013
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-9619
Country	:	US
Telephone Number	:	352-383-4446
Fax Number	:	352-383-4449

Provider Business Practice Location Address
First Line	:	2725 ROBIE AVE
Second Line	:	SUITE 2013
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-9619
Country	:	US
Telephone Number	:	352-383-4446
Fax Number	:	352-383-4449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2009
Last Update Date	:	01/29/2009

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