Provider Demographics
NPI:1083651632
Name:VALENTINE, KITTIE CORRINE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:KITTIE
Middle Name:CORRINE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8342
Mailing Address - Country:US
Mailing Address - Phone:561-747-6842
Mailing Address - Fax:
Practice Address - Street 1:12300 ALTERNATE A1A
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2205
Practice Address - Country:US
Practice Address - Phone:561-694-6803
Practice Address - Fax:561-694-6804
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8769Medicare ID - Type UnspecifiedPHYSICAL THERAOY PROVIDER