Healthcare Provider Details

I. General information

NPI: 1902197890
Provider Name (Legal Business Name): ROBERT KYLE ANDERSON RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8509 BENJAMIN RD STE D
TAMPA FL
33634-1224
US

IV. Provider business mailing address

8509 BENJAMIN RD STE D
TAMPA FL
33634-1224
US

V. Phone/Fax

Practice location:
  • Phone: 813-880-0220
  • Fax: 813-806-1828
Mailing address:
  • Phone: 813-880-0220
  • Fax: 813-806-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT4194
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: