Provider Demographics
NPI:1770830655
Name:OSTEEN, KATHLEEN SUE (PTA)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SUE
Last Name:OSTEEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 MIDDLETON DR SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-4226
Mailing Address - Country:US
Mailing Address - Phone:772-766-0404
Mailing Address - Fax:
Practice Address - Street 1:814 MIDDLETON DR SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-4226
Practice Address - Country:US
Practice Address - Phone:772-766-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20329225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant