Provider Demographics
NPI:1386298172
Name:FEMMEMPOWERMENT AND ADVOCACY
Entity type:Organization
Organization Name:FEMMEMPOWERMENT AND ADVOCACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLEE
Authorized Official - Middle Name:SHEA GARRETT
Authorized Official - Last Name:SIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:931-704-4540
Mailing Address - Street 1:11125 PARK BLVD STE 104-129
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4757
Mailing Address - Country:US
Mailing Address - Phone:931-704-4540
Mailing Address - Fax:727-362-1421
Practice Address - Street 1:655 31ST ST S STE A
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-1805
Practice Address - Country:US
Practice Address - Phone:727-828-6238
Practice Address - Fax:955-895-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1144774563OtherOUT OF NETWORK PROVIDER