Healthcare Provider Details

I. General information

NPI: 1194240226
Provider Name (Legal Business Name): KIMBERLY MOCCIA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 W LUMSDEN RD
BRANDON FL
33511-6261
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-2183
US

V. Phone/Fax

Practice location:
  • Phone: 813-253-3092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23087
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42714
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: