Individual
MS. KIM MARONEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
8455 S SUNCOAST BLVD, HOMOSASSA, FL 34446-5066
(352) 382-0939
Mailing address
8455 S SUNCOAST BLVD, HOMOSASSA, FL 34446-5066
(352) 567-5910
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA2259
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106898
MEDICARE ID
FL
Enumeration date
11/17/2008
Last updated
11/17/2008
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