Provider Demographics
NPI:1801997572
Name:DAVIS, KEARSTEN RITCHEL (PT)
Entity type:Individual
Prefix:
First Name:KEARSTEN
Middle Name:RITCHEL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KEARSTEN
Other - Middle Name:MICHELLE
Other - Last Name:RITCHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3633 W WATERS AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2783
Mailing Address - Country:US
Mailing Address - Phone:813-932-5119
Mailing Address - Fax:813-932-5539
Practice Address - Street 1:3633 W WATERS AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2783
Practice Address - Country:US
Practice Address - Phone:813-932-5119
Practice Address - Fax:813-932-5539
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist