Provider Demographics
NPI:1245060466
Name:HEENAN, KATHLEEN AMANDA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:AMANDA
Last Name:HEENAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 DOGWOOD FLOWER LN APT 101
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6885
Mailing Address - Country:US
Mailing Address - Phone:571-299-9175
Mailing Address - Fax:
Practice Address - Street 1:6912 ASPHALT AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3625
Practice Address - Country:US
Practice Address - Phone:813-773-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist