Provider Demographics
NPI:1356824569
Name:ROHALEY, KATHY D (PT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:D
Last Name:ROHALEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4607
Mailing Address - Country:US
Mailing Address - Phone:352-732-5590
Mailing Address - Fax:
Practice Address - Street 1:2755 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2226
Practice Address - Country:US
Practice Address - Phone:352-732-5590
Practice Address - Fax:352-732-0292
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPT29789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty