=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386844983
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAY KEELING DEERMAN P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2007
-----------------------------------------------------
Last Update Date | 03/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2684 SW IMMANUEL DR
-----------------------------------------------------
City | PALM CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34990-2738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-220-3444
-----------------------------------------------------
Fax | 772-220-3839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3539 SW CORPORATE PKWY
-----------------------------------------------------
City | PALM CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34990-8151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-220-3444
-----------------------------------------------------
Fax | 772-220-3839
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT2232
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------