Provider Demographics
NPI:1083644413
Name:BERO, KIM ELAINE (MS, RKT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ELAINE
Last Name:BERO
Suffix:
Gender:F
Credentials:MS, RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 HI VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-6604
Mailing Address - Country:US
Mailing Address - Phone:813-972-2000
Mailing Address - Fax:813-978-5968
Practice Address - Street 1:1300 B. B. DOWNS BLVD.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
755226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
755OtherNATIONAL REGISTRATION