Provider Demographics
NPI:1093765141
Name:DARE, KIM MARIE (PT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:DARE
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 1:12 WALNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-1600
Mailing Address - Country:US
Mailing Address - Phone:302-750-5486
Mailing Address - Fax:302-764-2019
Practice Address - Street 1:4001 MILLER RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-1961
Practice Address - Country:US
Practice Address - Phone:302-764-2008
Practice Address - Fax:302-764-2019
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE4562200OtherAETNA
DE4562200OtherAETNA