Provider Demographics
NPI:1093146516
Name:SAND, KIMBERLY (MPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SAND
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-2901
Mailing Address - Country:US
Mailing Address - Phone:609-713-0461
Mailing Address - Fax:
Practice Address - Street 1:8 ELMWOOD DR
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-2901
Practice Address - Country:US
Practice Address - Phone:609-713-0461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA917300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist