Provider Demographics
NPI:1083706295
Name:MARTIN, KIMBERLY DIANE (PT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DIANE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 W SESAME DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7962
Mailing Address - Country:US
Mailing Address - Phone:956-428-5440
Mailing Address - Fax:956-428-3375
Practice Address - Street 1:595 SESAME DR WEST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7962
Practice Address - Country:US
Practice Address - Phone:956-428-5440
Practice Address - Fax:956-428-3375
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT1070845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204544800OtherACS DEPARTMENT OF LABOR
TX134682101OtherVALLEY HEALTH PLANS
TX8T2359OtherBLUE CROSS BLUE SHIELD
TX166501001Medicaid