MEDICARE: MR. KIM ENEBERG PT

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	225100000X	Physical Therapist	PT35351	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT60648721	OTHER	WA	STATE LICENSE

General Provider Information

NPI Number	:	1255844916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KIM ENEBERG PT

Provider Business Mailing Address
First Line	:	3500 E FLETCHER AVE STE 133
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-4709
Country	:	US
Telephone Number	:	407-605-2321
Fax Number	:	407-671-4155

Provider Business Practice Location Address
First Line	:	3500 E FLETCHER AVE STE 133
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-4709
Country	:	US
Telephone Number	:	407-605-2321
Fax Number	:	407-671-4155

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

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	08/27/2025

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Directions to “ MR. KIM ENEBERG PT” Practice Location

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