Provider Demographics
NPI:1104340231
Name:CALVERT, KATHERINE MERCEDES (PT, DPT, CLWT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MERCEDES
Last Name:CALVERT
Suffix:
Gender:F
Credentials:PT, DPT, CLWT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MERCEDES
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3010 E 138TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3902
Mailing Address - Country:US
Mailing Address - Phone:813-805-8102
Mailing Address - Fax:
Practice Address - Street 1:3010 E 138TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3902
Practice Address - Country:US
Practice Address - Phone:813-805-8102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist