Provider Demographics
NPI:1003046590
Name:KAISER, KATRINA LYNNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:LYNNE
Last Name:KAISER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:LYNNE
Other - Last Name:SOMICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:709 S HARBOR CITY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1936
Mailing Address - Country:US
Mailing Address - Phone:321-802-5810
Mailing Address - Fax:321-802-5811
Practice Address - Street 1:5445 MURRELL RD STE 105
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6679
Practice Address - Country:US
Practice Address - Phone:321-802-5810
Practice Address - Fax:321-802-5811
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist