Individual
KIMBERLY M LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
38250 A AVE, ZEPHYRHILLS, FL, FL 33542
(813) 782-5508
Mailing address
1427 HOLLY RD, LAKELAND, FL 33801
(863) 430-3177
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA27309
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L520513905490
DR LICENSE
FL
Enumeration date
03/26/2018
Last updated
03/26/2018
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