Provider Demographics
NPI:1346431046
Name:COX, KELLY RAE (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:RAE
Last Name:COX
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 SHELL RD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-3341
Mailing Address - Country:US
Mailing Address - Phone:813-996-3504
Mailing Address - Fax:
Practice Address - Street 1:4202 E FOWLER AVE STOP ATH100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33620-8455
Practice Address - Country:US
Practice Address - Phone:813-974-0660
Practice Address - Fax:813-974-8541
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL21072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer