Healthcare Provider Details

I. General information

NPI: 1467602250
Provider Name (Legal Business Name): DARLENE KIRKPATRICK PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DARLENE KIRKPATRICK PTA

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14235 EDWINOLA WAY
DADE CITY FL
33523-3763
US

IV. Provider business mailing address

8455 S SUNCOAST BLVD
HOMOSASSA FL
34446-5066
US

V. Phone/Fax

Practice location:
  • Phone: 352-567-5910
  • Fax: 352-567-6860
Mailing address:
  • Phone: 352-567-5910
  • Fax: 352-567-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA21234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: