Healthcare Provider Details

I. General information

NPI: 1003046590
Provider Name (Legal Business Name): KATRINA LYNNE PELLEGRINI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA LYNNE KAISER PT

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 MURRELL RD STE 105
ROCKLEDGE FL
32955-6679
US

IV. Provider business mailing address

709 S HARBOR CITY BLVD STE 100
MELBOURNE FL
32901-1936
US

V. Phone/Fax

Practice location:
  • Phone: 321-802-5810
  • Fax: 321-802-5811
Mailing address:
  • Phone: 321-802-5810
  • Fax: 321-802-5811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24745
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: