Provider Demographics
NPI:1033363817
Name:SEGALL, KATHLEEN ANN (MA, LMT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:SEGALL
Suffix:
Gender:F
Credentials:MA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 PINELLAS BAYWAY S APT 404
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-1999
Mailing Address - Country:US
Mailing Address - Phone:727-515-5358
Mailing Address - Fax:727-865-6540
Practice Address - Street 1:5025 9TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6606
Practice Address - Country:US
Practice Address - Phone:727-515-5358
Practice Address - Fax:727-865-6540
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0028278204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC8824OtherBLUE CROSS BLUE SHIELD