Provider Demographics
NPI:1093014086
Name:SLEVIN, KATHRYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SLEVIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2062 KINGS PALACE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-2129
Mailing Address - Country:US
Mailing Address - Phone:517-304-4056
Mailing Address - Fax:
Practice Address - Street 1:1501 W CLEVELAND ST
Practice Address - Street 2:SUITE 220
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1812
Practice Address - Country:US
Practice Address - Phone:813-805-8101
Practice Address - Fax:813-254-3055
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist