Provider Demographics
NPI:1083069785
Name:AING, KIMBERLY SAM (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY SAM
Middle Name:
Last Name:AING
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5630
Mailing Address - Country:US
Mailing Address - Phone:713-277-8738
Mailing Address - Fax:
Practice Address - Street 1:1102 PINEMONT DR STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-1323
Practice Address - Country:US
Practice Address - Phone:713-277-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-01
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12709592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic