Provider Demographics
NPI:1548517246
Name:KING, KIMBERLY ANN (PT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4210 TAMARISK CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2022
Mailing Address - Country:US
Mailing Address - Phone:785-505-3129
Mailing Address - Fax:785-505-3126
Practice Address - Street 1:325 MAINE ST
Practice Address - Street 2:SUITE 1020
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1360
Practice Address - Country:US
Practice Address - Phone:785-505-3129
Practice Address - Fax:785-505-3126
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-0884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist