Healthcare Provider Details

I. General information

NPI: 1386444776
Provider Name (Legal Business Name): KATELYN PENTZ RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2025
Last Update Date: 03/15/2025
Certification Date: 03/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MICCOSUKEE RD
TALLAHASSEE FL
32308-5054
US

IV. Provider business mailing address

1610 YAUPON CT
MONTICELLO FL
32344-1060
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-1155
  • Fax:
Mailing address:
  • Phone: 850-242-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number20496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: