Healthcare Provider Details

I. General information

NPI: 1215060520
Provider Name (Legal Business Name): KIMBERLY SUE KETTINGER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY SUE HALTERMAN

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 OVERLOOK DR
WINTER HAVEN FL
33884-1626
US

IV. Provider business mailing address

3828 SARRIA AVE
SEBRING FL
33872-2300
US

V. Phone/Fax

Practice location:
  • Phone: 863-318-1315
  • Fax: 863-326-9432
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA19199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: