Healthcare Provider Details

I. General information

NPI: 1144054115
Provider Name (Legal Business Name): KHYRA JENAI GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 PARK PLACE BLVD
CLEARWATER FL
33759-4904
US

IV. Provider business mailing address

4417 RACHEL FALLS DR
TAMPA FL
33610-5641
US

V. Phone/Fax

Practice location:
  • Phone: 888-457-6430
  • Fax:
Mailing address:
  • Phone: 813-363-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA33620
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: