Provider Demographics
NPI:1033377254
Name:CROTEAU, KIMBERLY ANN (DOCTOR OF PHYS THER)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:CROTEAU
Suffix:
Gender:F
Credentials:DOCTOR OF PHYS THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BURTON DR STE 260
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3545
Mailing Address - Country:US
Mailing Address - Phone:707-449-3484
Mailing Address - Fax:707-449-1803
Practice Address - Street 1:1350 BURTON DR STE 260
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3545
Practice Address - Country:US
Practice Address - Phone:707-449-3484
Practice Address - Fax:707-449-1803
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist