Basic Information
| Provider Information | |||||||||
| NPI: | 1417351529 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRSCHNER | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | EVADNE | ||||||||
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| Credential: | P.T.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4559 ROSS LANIER LN | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347582137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078707785 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3350 W SOUTHPORT RD | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347462706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078460152 | ||||||||
| FaxNumber: | 4078461225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2014 | ||||||||
| LastUpdateDate: | 10/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA 13627 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.