Provider Demographics
NPI:1538361647
Name:NOBLES, KIM E (PT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:E
Last Name:NOBLES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 NW PRIMA VISTA BLVD. #105
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983
Mailing Address - Country:US
Mailing Address - Phone:772-873-8980
Mailing Address - Fax:772-873-8981
Practice Address - Street 1:441 NW PRIMA VISTA BLVD. #105
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:772-873-8980
Practice Address - Fax:772-873-8981
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY917ZOtherBCBS GROUP
FLY917ZOtherBCBS GROUP
FLPENDINGMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL