MEDICARE: MRS. KATHLEEN FARIS KANGAS D.P.T.

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	225100000X	Physical Therapist	40180	FL

General Provider Information

NPI Number	:	1508891102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN FARIS KANGAS D.P.T.

Provider Business Mailing Address
First Line	:	2133 SEDGES AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2970
Country	:	US
Telephone Number	:	202-288-5389
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 HARRISON AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2725
Country	:	US
Telephone Number	:	202-288-5389
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	12/05/2023

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