Provider Demographics
NPI:1871791459
Name:KEAN, VICTORIA A (ATC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:KEAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:A
Other - Last Name:KRAMPEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:29300 BIRDS EYE DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6571
Mailing Address - Country:US
Mailing Address - Phone:813-477-8215
Mailing Address - Fax:
Practice Address - Street 1:12901 BRUCE B DOWNS BLVD
Practice Address - Street 2:STE 4161, MDC 36
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4742
Practice Address - Country:US
Practice Address - Phone:813-396-9625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 19442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer