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General NPI Number Information
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NPI Number | 1881383909
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Entity Type | Organization
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Legal Business Name | KCA PHYSICAL THERAPY
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Dates
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Enumeration Date | 05/04/2023
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 1402 CAT MAR RD STE A
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City | NICEVILLE
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State | FL
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Zip | 32578-8904
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Country | US
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Telephone | 262-215-2963
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Fax | 833-869-6437
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Provider Business Mailing Address
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Address Line | 4327 SUNSET BEACH CIR
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City | NICEVILLE
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State | FL
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Zip | 32578-4820
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Country | US
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Telephone | 262-215-2963
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Fax | 833-869-6437
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Authorized Official
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Title or Position | OWNER
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Name | ALLISON EASTERLY
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Credential |
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Telephone | 262-215-2963
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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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