MEDICARE: MRS. KELLY JO DOTTORE 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
1	225100000X	Physical Therapist	22399	FL

General Provider Information

NPI Number	:	1992856140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY JO DOTTORE PT

Provider Business Mailing Address
First Line	:	636 HOLBROOK CIR
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-6334
Country	:	US
Telephone Number	:	407-924-7236
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 SEMORAN BLVD STE 227
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-6442
Country	:	US
Telephone Number	:	407-681-2999
Fax Number	:

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	11/24/2014

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