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General NPI Number Information
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NPI Number | 1417181900
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Entity Type | Organization
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Legal Business Name | HEALTHY TO THE BONE
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 9668 105TH TER
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City | LARGO
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State | FL
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Zip | 33773-4507
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Country | US
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Telephone | 727-397-1580
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Fax |
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Provider Business Mailing Address
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Address Line | 9668 105TH TER
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City | LARGO
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State | FL
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Zip | 33773-4507
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Country | US
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Telephone | 727-397-1580
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. KATHLEEN DEMOLLI SHIRLEY
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Credential | PT
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Telephone | 727-460-1802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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