Provider Demographics
NPI:1194840876
Name:DAMBROGIO, KERRY (DOM AP PT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:DAMBROGIO
Suffix:
Gender:M
Credentials:DOM AP PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7311 MERCHANT CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8489
Mailing Address - Country:US
Mailing Address - Phone:941-907-9250
Mailing Address - Fax:941-907-8280
Practice Address - Street 1:7311 MERCHANT CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8489
Practice Address - Country:US
Practice Address - Phone:941-907-9250
Practice Address - Fax:941-907-8280
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1549171100000X
FLPT7373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY5873ZMedicare ID - Type Unspecified