Provider Demographics
NPI:1902060890
Name:BRUNT, KIMBERLY SUZANNE (LPTA)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:SUZANNE
Last Name:BRUNT
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:540 ABERTHAW AVE
Mailing Address - Street 2:VIRGINIA HEALTH REHABILITATION AGENCY LLC
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601
Mailing Address - Country:US
Mailing Address - Phone:757-595-1946
Mailing Address - Fax:757-595-3238
Practice Address - Street 1:1200 ATLANTIC SHORES DRIVE
Practice Address - Street 2:SEASIDE HEALTHCARE CENTER AT ATLANTIC SHORES
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-716-2150
Practice Address - Fax:757-716-2027
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2306000395225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant