Provider Demographics
NPI:1912039520
Name:THERRIEN, KARA LEE (MSPT)
Entity Type:Individual
Prefix:MISS
First Name:KARA
Middle Name:LEE
Last Name:THERRIEN
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 1:27 SUMMIT LN
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-5423
Mailing Address - Country:US
Mailing Address - Phone:727-743-0059
Mailing Address - Fax:
Practice Address - Street 1:1944 N HERCULES AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-4403
Practice Address - Country:US
Practice Address - Phone:727-797-8100
Practice Address - Fax:727-797-8110
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist