Provider Demographics
NPI:1679675243
Name:SHIRLEY, KATHLEEN DEMOLLI (PT,OCS,GCS)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:DEMOLLI
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:PT,OCS,GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9668 105TH TER
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-4507
Mailing Address - Country:US
Mailing Address - Phone:727-791-0097
Mailing Address - Fax:
Practice Address - Street 1:9668 105TH TER
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-4507
Practice Address - Country:US
Practice Address - Phone:727-460-1802
Practice Address - Fax:727-397-1580
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist