Individual
MR. KEVIN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
614 E ROSEWOOD LN, TAVARES, FL 32778-4879
(863) 255-4702
Mailing address
614 E ROSEWOOD LN, TAVARES, FL 32778-4879
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PTA 19561
FL
Other
Enumeration date
12/14/2011
Last updated
12/14/2011
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