Provider Demographics
NPI:1134489982
Name:PFAFF, KIMBERLEE (CPO)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:
Last Name:PFAFF
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 LOUIS PASTEUR DR
Mailing Address - Street 2:STE 160
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4537
Mailing Address - Country:US
Mailing Address - Phone:210-614-9222
Mailing Address - Fax:210-614-9333
Practice Address - Street 1:7220 LOUIS PASTEUR DR
Practice Address - Street 2:STE 160
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4537
Practice Address - Country:US
Practice Address - Phone:210-614-9222
Practice Address - Fax:210-614-9333
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1462222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist