Provider Demographics
NPI:1225706815
Name:PEARCE BAEZ, KELLY BROOKE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:BROOKE
Last Name:PEARCE BAEZ
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 1:20110 BLUE DAZE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2965
Mailing Address - Country:US
Mailing Address - Phone:352-426-1751
Mailing Address - Fax:
Practice Address - Street 1:13328 TELECOM DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0938
Practice Address - Country:US
Practice Address - Phone:813-771-0777
Practice Address - Fax:813-771-0877
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist