Provider Demographics
NPI:1043378052
Name:RUTHERFORD, KIMBERLY L (MPT, DSC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:MPT, DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 COURT ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5802
Mailing Address - Country:US
Mailing Address - Phone:727-442-7500
Mailing Address - Fax:
Practice Address - Street 1:1206 COURT ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5802
Practice Address - Country:US
Practice Address - Phone:727-442-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist