Provider Demographics
NPI:1861586471
Name:WOPSHALL, KIMBERLY G (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:G
Last Name:WOPSHALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:G
Other - Last Name:WYSZUMIALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3039 PLUMBROOK DR.
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537
Mailing Address - Country:US
Mailing Address - Phone:419-882-5954
Mailing Address - Fax:419-474-2505
Practice Address - Street 1:3039 PLUMBROOK DR.
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:419-882-5954
Practice Address - Fax:419-474-2505
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
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
OH2468477Medicaid
OH2468477Medicaid
OHWY4040801Medicare ID - Type Unspecified