Provider Demographics
NPI:1992258883
Name:MOFFITT, KATHRYN (PTA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 LAKE HOWELL RD
Mailing Address - Street 2:SUITE 1031
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5926
Mailing Address - Country:US
Mailing Address - Phone:407-671-0433
Mailing Address - Fax:407-671-2433
Practice Address - Street 1:405 LAKE HOWELL RD
Practice Address - Street 2:SUITE 1031
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5926
Practice Address - Country:US
Practice Address - Phone:407-671-0433
Practice Address - Fax:407-671-2433
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26898225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant