Provider Demographics
NPI:1487982476
Name:SCULLY, KARRIN L (MSPT)
Entity type:Individual
Prefix:
First Name:KARRIN
Middle Name:L
Last Name:SCULLY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14727 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-1652
Mailing Address - Country:US
Mailing Address - Phone:941-744-1305
Mailing Address - Fax:
Practice Address - Street 1:14727 1ST AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-1652
Practice Address - Country:US
Practice Address - Phone:941-744-1305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist