Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 24745 | FL |
NPI | 1003046590 |
---|---|
Provider Name | Mrs. Katrina Lynne Kaiser |
First Address | Melbourne, FL 32901-1936 |
Second Address | Rockledge, FL 32955-6679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2009 |
Last Update Date | 17/03/2018 |