Provider Demographics
NPI:1366591752
Name:KILKELLY, KAREN FRANCES ANNE (MPT)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:FRANCES ANNE
Last Name:KILKELLY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:FRANCES ANNE
Other - Last Name:CONSOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:6508 GUNN HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4022
Mailing Address - Country:US
Mailing Address - Phone:813-963-6923
Mailing Address - Fax:813-264-0768
Practice Address - Street 1:6508 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4022
Practice Address - Country:US
Practice Address - Phone:813-963-6923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0017701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11939501OtherCITRUS HMO
FL354702OtherWELLCARE
FL47782OtherBCBS