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General NPI Number Information
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NPI Number | 1902920523
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Entity Type | Individual
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Provider Name | KEVIN PATRICK ANDERSON M.P.T., CSCS
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1155 S ORLANDO AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-4852
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Country | US
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Telephone | 321-277-9314
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Fax | 407-628-2572
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Provider Business Mailing Address
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Address Line | 770 HUNTINGTON PINES DR
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City | OCOEE
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State | FL
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Zip | 34761-3368
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Country | US
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Telephone | 321-277-9314
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT18060
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License Number State | FL
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