Healthcare Provider Details

I. General information

NPI: 1952451874
Provider Name (Legal Business Name): KATHLEEN H KANE MA, PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN HICKEY MA, PT, ATC

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14813 N DALE MABRY HWY
TAMPA FL
33618-2027
US

IV. Provider business mailing address

14813 N DALE MABRY HWY
TAMPA FL
33618-2027
US

V. Phone/Fax

Practice location:
  • Phone: 813-964-5982
  • Fax:
Mailing address:
  • Phone: 813-964-5982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004445
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000201
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT30755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: