Provider Demographics
NPI:1144774563
Name:GARRETT SIMMERMAN, KAYLEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:GARRETT SIMMERMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11125 PARK BLVD STE 104-129
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4757
Mailing Address - Country:US
Mailing Address - Phone:931-704-4540
Mailing Address - Fax:727-362-1421
Practice Address - Street 1:655 31ST ST S STE A
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-1805
Practice Address - Country:US
Practice Address - Phone:727-828-6238
Practice Address - Fax:855-965-0912
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
FL31916225100000X
FLPT31916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL831492031OtherOUT OF NETWORK PROVIDER