Individual
MR. KENNETH DARYL TIBBETTS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
719 E ROBSON ST, TAMPA, FL 33604-4224
(813) 712-0618
Mailing address
719 E ROBSON ST, TAMPA, FL 33604-4224
(813) 712-0618
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
28226
FL
Other
Enumeration date
09/24/2020
Last updated
09/24/2020
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