Provider Demographics
NPI:1417581026
Name:KELLY, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:DEBLASI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11224 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4752
Mailing Address - Country:US
Mailing Address - Phone:727-394-0949
Mailing Address - Fax:727-394-7031
Practice Address - Street 1:11224 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4752
Practice Address - Country:US
Practice Address - Phone:727-394-0949
Practice Address - Fax:727-394-7031
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0284252251X0800X
FLPT38450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic