Provider Demographics
NPI:1366559940
Name:FOX, KERRY MARTIN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:KERRY
Middle Name:MARTIN
Last Name:FOX
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 8TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2406
Mailing Address - Country:US
Mailing Address - Phone:727-398-6661
Mailing Address - Fax:727-398-9440
Practice Address - Street 1:10,000 BAY PINES BLVD.
Practice Address - Street 2:
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744-5005
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-398-9440
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist