MEDICARE: MRS. KATHLEEN H KANE MA, 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
1	225100000X	Physical Therapist	004445	CT
2	2255A2300X	Athletic Trainer	000201	CT
3	2251X0800X	Orthopedic Physical Therapist	PT30755	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00063062	OTHER	CT	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6404276	OTHER	CT	UHC
3	P3254653	OTHER	CT	OXFORD PROVIDER ID
4	08000445CT07	OTHER	CT	BLUE CROSS BLUE SHIELD
5	2307725	OTHER	CT	AETNA PROVIDER ID
6	2V4086	OTHER	CT	PHS HEALTHNET PROVIDER ID

General Provider Information

NPI Number	:	1952451874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN H KANE MA, PT, ATC

Provider Business Mailing Address
First Line	:	14813 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2027
Country	:	US
Telephone Number	:	813-964-5982
Fax Number	:

Provider Business Practice Location Address
First Line	:	14813 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2027
Country	:	US
Telephone Number	:	813-964-5982
Fax Number	:

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	12/31/2015

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Directions to “ MRS. KATHLEEN H KANE MA, PT, ATC” Practice Location

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