Provider Demographics
NPI:1730635004
Name:SEARCY, KRISTIN CAMPBELL (DPT)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:CAMPBELL
Last Name:SEARCY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:ELIZABETH
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2881 NE OLD BLUE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:FL
Mailing Address - Zip Code:32059-4539
Mailing Address - Country:US
Mailing Address - Phone:850-464-0594
Mailing Address - Fax:
Practice Address - Street 1:235 SW DADE ST STE B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2363
Practice Address - Country:US
Practice Address - Phone:850-973-2929
Practice Address - Fax:850-973-3939
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT31477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 31477OtherSTATE PHYSICAL THERAPY LICENSE
FL018885600Medicaid