Healthcare Provider Details

I. General information

NPI: 1881383909
Provider Name (Legal Business Name): KCA PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 CAT MAR RD STE A
NICEVILLE FL
32578-8904
US

IV. Provider business mailing address

4327 SUNSET BEACH CIR
NICEVILLE FL
32578-4820
US

V. Phone/Fax

Practice location:
  • Phone: 262-215-2963
  • Fax: 833-869-6437
Mailing address:
  • Phone: 262-215-2963
  • Fax: 833-869-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLISON EASTERLY
Title or Position: OWNER
Credential:
Phone: 262-215-2963