Healthcare Provider Details

I. General information

NPI: 1649819004
Provider Name (Legal Business Name): KAYLYN STEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13656 ARTESA BELL DR
RIVERVIEW FL
33579-2396
US

IV. Provider business mailing address

13656 ARTESA BELL DR
RIVERVIEW FL
33579-2396
US

V. Phone/Fax

Practice location:
  • Phone: 813-951-5801
  • Fax:
Mailing address:
  • Phone: 813-951-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number24324
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: