Provider Demographics
NPI:1225210883
Name:SOUDER, KATHY C (LMT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:C
Last Name:SOUDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 HUTCHISON RD
Mailing Address - Street 2:STE. 115
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5511
Mailing Address - Country:US
Mailing Address - Phone:813-962-7001
Mailing Address - Fax:813-962-7004
Practice Address - Street 1:15100 HUTCHISON RD
Practice Address - Street 2:STE. 115
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5511
Practice Address - Country:US
Practice Address - Phone:813-962-7001
Practice Address - Fax:813-962-7004
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40774225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
02OtherCOMMERCIAL CARRIERS