Provider Demographics
NPI:1144490277
Name:WORD, KISIAH MORRIS (DPT)
Entity type:Individual
Prefix:
First Name:KISIAH
Middle Name:MORRIS
Last Name:WORD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KISIAH
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:929 VANDERBILT DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-5254
Mailing Address - Country:US
Mailing Address - Phone:352-459-6790
Mailing Address - Fax:
Practice Address - Street 1:3140 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5252
Practice Address - Country:US
Practice Address - Phone:523-253-3892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist