Provider Demographics
NPI:1013944560
Name:DORIS, KEVIN PAUL (PT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:PAUL
Last Name:DORIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 MAST CT
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-3959
Mailing Address - Country:US
Mailing Address - Phone:813-679-1961
Mailing Address - Fax:
Practice Address - Street 1:7815 N DALE MABRY HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-932-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2906996OtherCIGNA
FL7822407OtherAETNA PPO
FL222535OtherAMERIGROUP
FL522344261OtherHUMANA
FLY0571OtherBCBS
FL3041824OtherAETNA HMO
FL222535OtherAMERIGROUP
FLK3223Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER