Provider Demographics
NPI:1245739606
Name:KITE-HENRY, MEGAN LEE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LEE
Last Name:KITE-HENRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 JASPER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4085
Mailing Address - Country:US
Mailing Address - Phone:813-476-4222
Mailing Address - Fax:
Practice Address - Street 1:1311 ASTON GARDENS CT
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-3824
Practice Address - Country:US
Practice Address - Phone:813-642-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA27367225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant