Provider Demographics
NPI:1083182455
Name:MCCLURE, KIMBERLY (PT, DPT, NTMTC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:PT, DPT, NTMTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 WILSON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1972
Mailing Address - Country:US
Mailing Address - Phone:832-308-0381
Mailing Address - Fax:832-412-2983
Practice Address - Street 1:4830 WILSON RD STE 300
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-1972
Practice Address - Country:US
Practice Address - Phone:832-308-0381
Practice Address - Fax:832-412-2983
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1296551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist