Provider Demographics
NPI:1619708468
Name:MASTERS, KAILEY ANNE (DPT)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:ANNE
Last Name:MASTERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 N ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-8655
Mailing Address - Country:US
Mailing Address - Phone:941-460-3831
Mailing Address - Fax:941-460-3831
Practice Address - Street 1:100 MADRID BLVD STE 212
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-7968
Practice Address - Country:US
Practice Address - Phone:941-646-8510
Practice Address - Fax:941-218-5627
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist