MEDICARE: MS. KELLIE SUZANNE MASSIE-OSBORNE P.T.

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
1	174400000X	Specialist	FLPT16875	FL

General Provider Information

NPI Number	:	1073684080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLIE SUZANNE MASSIE-OSBORNE P.T.

Provider Business Mailing Address
First Line	:	133 107TH AVE
Second Line	:
City	:	TREASURE ISLAND
State	:	FL
Zip	:	33706-4715
Country	:	US
Telephone Number	:	727-360-6652
Fax Number	:	727-363-4428

Provider Business Practice Location Address
First Line	:	133 107TH AVE
Second Line	:
City	:	TREASURE ISLAND
State	:	FL
Zip	:	33706-4715
Country	:	US
Telephone Number	:	727-360-6652
Fax Number	:	727-363-4428

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	06/27/2014

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