Provider Demographics
NPI:1902897382
Name:JOHNK, KIMBERLY LYNN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:JOHNK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:LYNN
Other - Last Name:NOLTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:6774 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:PANORA
Mailing Address - State:IA
Mailing Address - Zip Code:50216-8714
Mailing Address - Country:US
Mailing Address - Phone:641-755-2466
Mailing Address - Fax:
Practice Address - Street 1:2400 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115-8878
Practice Address - Country:US
Practice Address - Phone:641-747-3225
Practice Address - Fax:641-747-3045
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIOWA01775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist