Provider Demographics
NPI:1588822126
Name:SCHOLL, KATHERINE CANCINO (MSPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CANCINO
Last Name:SCHOLL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SE GOLDTREE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7583
Mailing Address - Country:US
Mailing Address - Phone:772-335-7966
Mailing Address - Fax:772-335-7963
Practice Address - Street 1:2150 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2462
Practice Address - Country:US
Practice Address - Phone:305-860-6383
Practice Address - Fax:305-860-6526
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist