Provider Demographics
NPI:1730602897
Name:KITTAY, LANCE SCOTT (MPT)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:SCOTT
Last Name:KITTAY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13880 DOMINICA DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-1316
Mailing Address - Country:US
Mailing Address - Phone:727-433-0361
Mailing Address - Fax:
Practice Address - Street 1:13880 DOMINICA DR
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-1316
Practice Address - Country:US
Practice Address - Phone:727-433-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty