Healthcare Provider Details

I. General information

NPI: 1295879575
Provider Name (Legal Business Name): SCOTT E KALE PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 34TH ST S
ST PETERSBURG FL
33711-4367
US

IV. Provider business mailing address

8158 NATURES WAY APT 33
BRADENTON FL
34202-4133
US

V. Phone/Fax

Practice location:
  • Phone: 727-867-0737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number20542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: