Provider Demographics
NPI:1093233900
Name:KIMMETT, ZAK A (DPT)
Entity Type:Individual
Prefix:
First Name:ZAK
Middle Name:A
Last Name:KIMMETT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 15TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-5618
Mailing Address - Country:US
Mailing Address - Phone:727-616-0809
Mailing Address - Fax:727-290-4896
Practice Address - Street 1:6619 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1305
Practice Address - Country:US
Practice Address - Phone:727-616-0809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT11501225100000X
FLPT35378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPT11501OtherPT LICENSE