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General NPI Number Information
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NPI Number | 1780941708
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Entity Type | Individual
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Provider Name | KAITLYN PETRONE PTA
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Gender | Female
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Dates
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Enumeration Date | 04/16/2012
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Last Update Date | 04/16/2012
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Provider Practice Location Address
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Address Line | 15204 W COLONIAL DR
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City | WINTER GARDEN
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State | FL
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Zip | 34787
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Country | US
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Telephone | 407-877-2394
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6197
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City | CHINA VILLAGE
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State | ME
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Zip | 04926-0197
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Country | US
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Telephone | 207-877-5283
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 22834
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License Number State | FL
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