Provider Demographics
NPI:1093979965
Name:SIROIS, KIMBERLY MARION (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARION
Last Name:SIROIS
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 1:1 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:EDGECOMB
Mailing Address - State:ME
Mailing Address - Zip Code:04556-3201
Mailing Address - Country:US
Mailing Address - Phone:207-882-9832
Mailing Address - Fax:
Practice Address - Street 1:51 WINSHIP ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2843
Practice Address - Country:US
Practice Address - Phone:207-443-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist