Provider Demographics
NPI:1629234661
Name:NEUHART, KATHLEEN ELISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ELISE
Last Name:NEUHART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:ELISE
Other - Last Name:HEINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1751 SARNO RD
Mailing Address - Street 2:# 3
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4909
Mailing Address - Country:US
Mailing Address - Phone:321-253-8088
Mailing Address - Fax:
Practice Address - Street 1:1751 SARNO RD
Practice Address - Street 2:# 3
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4909
Practice Address - Country:US
Practice Address - Phone:321-253-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist