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General NPI Number Information
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NPI Number | 1871791459
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Entity Type | Individual
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Provider Name | VICTORIA A KEAN ATC
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Gender | Female
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12901 BRUCE B DOWNS BLVD STE 4161, MDC 36
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City | TAMPA
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State | FL
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Zip | 33612-4742
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Country | US
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Telephone | 813-396-9625
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Fax |
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Provider Business Mailing Address
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Address Line | 29300 BIRDS EYE DR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-6571
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Country | US
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Telephone | 813-477-8215
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL 1944
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License Number State | FL
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