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NPI Code Detail

MEDICARE: LISA K KITTREDGE PTA

MEDICARE: LISA K KITTREDGE 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 AssistantPTA19895FL

General Provider Information

NPI Number : 1669649414
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA K KITTREDGE PTA
Provider Business Mailing Address
First Line : 8455 S SUNCOAST BLVD
Second Line :
City : HOMOSASSA
State : FL
Zip : 34446-5066
Country : US
Telephone Number : 352-382-0939
Fax Number : 352-382-4297
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 : 352-382-4297
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2008
Last Update Date : 05/12/2008

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Directions to “ LISA K KITTREDGE PTA” Practice Location

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