MEDICARE: DR. KATHLEEN LEOTTA D.C

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	111NR0400X	Rehabilitation Chiropractor	CH7977	FL

General Provider Information

NPI Number	:	1275745853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN LEOTTA D.C

Provider Business Mailing Address
First Line	:	4602 N ARMENIA AVE STE B4
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2600
Country	:	US
Telephone Number	:	813-874-6600
Fax Number	:	813-874-6601

Provider Business Practice Location Address
First Line	:	4602 N ARMENIA AVE STE B4
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2600
Country	:	US
Telephone Number	:	813-874-6600
Fax Number	:	813-874-6601

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	03/16/2010

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