Provider Demographics
NPI:1033280250
Name:BISSON, KIMBERLY A (PT7811)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:BISSON
Suffix:
Gender:F
Credentials:PT7811
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18710 MERIDIAN E
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2231
Mailing Address - Country:US
Mailing Address - Phone:253-875-6826
Mailing Address - Fax:253-875-1547
Practice Address - Street 1:18710 MERIDIAN E
Practice Address - Street 2:SUITE 215
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-2231
Practice Address - Country:US
Practice Address - Phone:253-875-6826
Practice Address - Fax:253-875-1547
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT7811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA192549OtherWORKERS COMPENSATION
WA8368847Medicaid
WA192549OtherWORKERS COMPENSATION