Healthcare Provider Details

I. General information

NPI: 1255844916
Provider Name (Legal Business Name): KIM ENEBERG PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 E FLETCHER AVE STE 133
TAMPA FL
33613-4709
US

IV. Provider business mailing address

3500 E FLETCHER AVE STE 133
TAMPA FL
33613-4709
US

V. Phone/Fax

Practice location:
  • Phone: 407-605-2321
  • Fax: 407-671-4155
Mailing address:
  • Phone: 407-605-2321
  • Fax: 407-671-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT35351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: