Provider Demographics
NPI:1952451874
Name:KANE, KATHLEEN H (MA, PT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:H
Last Name:KANE
Suffix:
Gender:F
Credentials:MA, PT, ATC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:HICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, PT, ATC
Mailing Address - Street 1:14813 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2027
Mailing Address - Country:US
Mailing Address - Phone:813-964-5982
Mailing Address - Fax:
Practice Address - Street 1:14813 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2027
Practice Address - Country:US
Practice Address - Phone:813-964-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004445225100000X
CT0002012255A2300X
FLPT307552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6404276OtherUHC
CTP00063062OtherRR MEDICARE
CTP3254653OtherOXFORD PROVIDER ID
CT08000445CT07OtherBLUE CROSS BLUE SHIELD
CT2307725OtherAETNA PROVIDER ID
CT2V4086OtherPHS HEALTHNET PROVIDER ID
CT6404276OtherUHC