MEDICARE: MRS. KIMBERLY KAE FANE 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 1551	FL

General Provider Information

NPI Number	:	1679613160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY KAE FANE PTA

Provider Business Mailing Address
First Line	:	3602 DUFFER RD
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-1201
Country	:	US
Telephone Number	:	863-386-4809
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 US HIGHWAY 27 N
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-1221
Country	:	US
Telephone Number	:	863-471-1223
Fax Number	:	863-471-2015

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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