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General NPI Number Information
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NPI Number | 1508904350
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Entity Type | Individual
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Provider Name | MARK EDWARD KLEEB PT, CEAS
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1119 SAXON BLVD
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City | ORANGE CITY
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State | FL
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Zip | 32763-8470
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Country | US
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Telephone | 386-216-1237
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Fax | 386-774-2192
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Provider Business Mailing Address
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Address Line | 781 PICKERINGTON PLACE
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City | OVIEDO
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State | FL
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Zip | 32765-8301
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Country | US
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Telephone | 407-366-4402
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Fax | 407-366-4402
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT14174
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License Number State | FL
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