Provider Demographics
NPI:1659679892
Name:DEECK, KIMBERLY JEAN (MSPT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:DEECK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 ROCKLEDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3769
Mailing Address - Country:US
Mailing Address - Phone:321-674-5035
Mailing Address - Fax:321-674-5039
Practice Address - Street 1:689 S APOLLO BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1455
Practice Address - Country:US
Practice Address - Phone:321-674-5035
Practice Address - Fax:321-674-5039
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-12
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT302052251X0800X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA040128OtherPHYSICAL THERAPY MEDICARE PROVIDER NUMBER