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NPI Code Detail

MEDICARE: KATHERINE ALICIA BLEIL O'CONNELL PT

MEDICARE: KATHERINE ALICIA BLEIL O'CONNELL 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
1225100000XPhysical TherapistPT39559FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT39559OTHERFLLICENSE

General Provider Information

NPI Number : 1891493201
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE ALICIA BLEIL O'CONNELL PT
Provider Business Mailing Address
First Line : 1446 SE 18TH TER
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-4526
Country : US
Telephone Number : 269-767-5544
Fax Number :
Provider Business Practice Location Address
First Line : 7820 FANNING CT
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-8508
Country : US
Telephone Number : 269-767-5544
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2023
Last Update Date : 02/16/2023

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