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NPI Code Detail

MEDICARE: MRS. SUSAN MARIE KANE PT, ATC

MEDICARE: MRS. SUSAN MARIE KANE PT, ATC
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
12255A2300XAthletic TrainerAL 1108FL
2225100000XPhysical TherapistPT 19127FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y134FOTHERFLBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932137494
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN MARIE KANE PT, ATC
Provider Business Mailing Address
First Line : 500 E CENTRAL AVE
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33880-3094
Country : US
Telephone Number : 863-293-1191
Fax Number : 863-507-2227
Provider Business Practice Location Address
First Line : 3000 WOODMONT AVE
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33884-3800
Country : US
Telephone Number : 863-293-1191
Fax Number : 863-508-2277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 10/07/2024

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