Provider Demographics
NPI:1053361733
Name:CSABI, KIM B (ATC, LAT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:B
Last Name:CSABI
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 NEWTON RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-6795
Mailing Address - Country:US
Mailing Address - Phone:386-767-8450
Mailing Address - Fax:386-767-8450
Practice Address - Street 1:1200 W INTERNATIONAL SPEEDWAY BLVD
Practice Address - Street 2:ATHLETIC DEPARTMENT
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2817
Practice Address - Country:US
Practice Address - Phone:386-506-3989
Practice Address - Fax:386-506-4485
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL968174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist