Healthcare Provider Details

I. General information

NPI: 1245348804
Provider Name (Legal Business Name): PATRICIA KAY SUBLETT P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 N TYNDALL PKWY
CALLAWAY FL
32404-9495
US

IV. Provider business mailing address

807 N TYNDALL PKWY
CALLAWAY FL
32404-9495
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-0505
  • Fax: 850-763-0966
Mailing address:
  • Phone: 850-763-0505
  • Fax: 850-763-0966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH1787
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberFL 6666
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: