Individual
KAITLYN MACKENZIE BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2519 S ORANGE AVE, ORLANDO, FL 32806-4545
(407) 648-1697
Mailing address
2519 S ORANGE AVE, ORLANDO, FL 32806-4545
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
PTAT34078
FL
Other
Enumeration date
06/12/2025
Last updated
06/12/2025
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