1528037884 NPI number — CHRISTINE CLAIRE KELLOGG P.T., D.O.M.

Table of content: CHRISTINE CLAIRE KELLOGG P.T., D.O.M. (NPI 1528037884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528037884 NPI number — CHRISTINE CLAIRE KELLOGG P.T., D.O.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELLOGG
Provider First Name:
CHRISTINE
Provider Middle Name:
CLAIRE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T., D.O.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528037884
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5702 BAYWATER DR
Provider Second Line Business Mailing Address:
TAMPA
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33615-3519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-294-0554
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 N ROCKY POINT DR E
Provider Second Line Business Practice Location Address:
SUITE 185
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33607-5810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-289-9613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AP1643 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT14546 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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