Provider Demographics
NPI:1528446200
Name:TEVIS, KIMBERLY (ATC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:TEVIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16515 MERIDIAN E
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6251
Mailing Address - Country:US
Mailing Address - Phone:253-840-5511
Mailing Address - Fax:253-840-0835
Practice Address - Street 1:16515 MERIDIAN E
Practice Address - Street 2:SUITE 202B
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6251
Practice Address - Country:US
Practice Address - Phone:253-840-5511
Practice Address - Fax:253-840-0835
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAA1 601342922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer