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NPI Code Detail

MEDICARE: MS. KIM MARONEY PTA

MEDICARE: MS. KIM MARONEY PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantPTA2259FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1106898OTHERFLMEDICARE ID

General Provider Information

NPI Number : 1043465172
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIM MARONEY PTA
Provider Business Mailing Address
First Line : 8455 S SUNCOAST BLVD
Second Line :
City : HOMOSASSA
State : FL
Zip : 34446-5066
Country : US
Telephone Number : 352-567-5910
Fax Number :
Provider Business Practice Location Address
First Line : 8455 S SUNCOAST BLVD
Second Line :
City : HOMOSASSA
State : FL
Zip : 34446-5066
Country : US
Telephone Number : 352-382-0939
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2008
Last Update Date : 11/17/2008

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