Healthcare Provider Details

I. General information

NPI: 1508904350
Provider Name (Legal Business Name): MARK EDWARD KLEEB PT, CEAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 SAXON BLVD
ORANGE CITY FL
32763-8470
US

IV. Provider business mailing address

781 PICKERINGTON PLACE
OVIEDO FL
32765-8301
US

V. Phone/Fax

Practice location:
  • Phone: 386-216-1237
  • Fax: 386-774-2192
Mailing address:
  • Phone: 407-366-4402
  • Fax: 407-366-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT14174
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: