Provider Demographics
NPI:1023018116
Name:MCBRIDE, KIMBERLY A (DPT MTC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:DPT MTC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:MATAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT MTC
Mailing Address - Street 1:2075 BARKLEY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6696
Mailing Address - Country:US
Mailing Address - Phone:360-733-4008
Mailing Address - Fax:360-733-4064
Practice Address - Street 1:2075 BARKLEY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6696
Practice Address - Country:US
Practice Address - Phone:360-733-4008
Practice Address - Fax:360-733-4064
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2885853OtherCIGNA
WA0236359OtherLABOR & INDUSTRY
WA8362246Medicaid
WA0236359OtherLABOR & INDUSTRY
WA2885853OtherCIGNA