Provider Demographics
NPI:1437379443
Name:LONG, KY-ANN (MS, PT)
Entity Type:Individual
Prefix:
First Name:KY-ANN
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:MRS
Other - First Name:KY-ANN
Other - Middle Name:LONG
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, PT
Mailing Address - Street 1:6516 MOONSHELL CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7560
Mailing Address - Country:US
Mailing Address - Phone:407-902-4961
Mailing Address - Fax:
Practice Address - Street 1:5979 VINELAND RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7800
Practice Address - Country:US
Practice Address - Phone:407-354-3906
Practice Address - Fax:407-354-3907
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-21064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist