MEDICARE: MISS KARA LEE THERRIEN MSPT

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	22754	FL

General Provider Information

NPI Number	:	1912039520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KARA LEE THERRIEN MSPT

Provider Business Mailing Address
First Line	:	27 SUMMIT LN
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-5423
Country	:	US
Telephone Number	:	727-743-0059
Fax Number	:

Provider Business Practice Location Address
First Line	:	1944 N HERCULES AVE
Second Line	:	SUITE C
City	:	CLEARWATER
State	:	FL
Zip	:	33763-4403
Country	:	US
Telephone Number	:	727-797-8100
Fax Number	:	727-797-8110

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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