Provider Demographics
NPI:1649304387
Name:GALICA, KATHLEEN (DPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GALICA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:G
Other - Last Name:DEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2033 WOOD ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-7900
Mailing Address - Country:US
Mailing Address - Phone:941-955-1107
Mailing Address - Fax:941-955-1156
Practice Address - Street 1:1232 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4507
Practice Address - Country:US
Practice Address - Phone:941-493-6449
Practice Address - Fax:941-496-4227
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY5219UMedicare PIN
FLY5219Medicare ID - Type UnspecifiedMEDICARE
FLY5219ZMedicare PIN
FLY5219YMedicare PIN