Provider Demographics
NPI:1104840024
Name:BURNS, KIMBERLY A (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:BURNS
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 1:600 NW 11TH
Mailing Address - Street 2:SUITE E-31
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-9696
Mailing Address - Country:US
Mailing Address - Phone:541-667-3657
Mailing Address - Fax:541-667-3659
Practice Address - Street 1:600 NW 11TH
Practice Address - Street 2:SUITE E-31
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-9696
Practice Address - Country:US
Practice Address - Phone:541-667-3657
Practice Address - Fax:541-667-3659
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPT 6680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807455600Medicaid
ID807455600Medicaid