Provider Demographics
NPI:1134286206
Name:BRINK, KIMBERLY JEAN (MSPT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:BRINK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:BERESFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57004-0307
Mailing Address - Country:US
Mailing Address - Phone:605-484-3231
Mailing Address - Fax:888-313-7818
Practice Address - Street 1:407 W ELM ST
Practice Address - Street 2:
Practice Address - City:BERESFORD
Practice Address - State:SD
Practice Address - Zip Code:57004-2150
Practice Address - Country:US
Practice Address - Phone:605-484-3231
Practice Address - Fax:888-313-7818
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD05932251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5833610Medicaid