Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT8622 | FL |
Y | 213ES0000X | Sports Medicine | PT8622 | FL |
NPI | 1215459425 |
---|---|
Provider Name | Kathryn Lennon |
First Address | Longwood, FL 32779-4566 |
Second Address | Winter Garden, FL 34787-7013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2017 |
Last Update Date | 10/07/2017 |