Provider Demographics
NPI:1164553335
Name:LEVENHAGEN, KIMBERLY DIANE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DIANE
Last Name:LEVENHAGEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:PROF
Other - First Name:KIMBERLY
Other - Middle Name:MOORE
Other - Last Name:LEVENHAGEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:506 WEBSTER PATH CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3941
Mailing Address - Country:US
Mailing Address - Phone:314-963-1171
Mailing Address - Fax:314-968-8298
Practice Address - Street 1:3437 CAROLINE ST
Practice Address - Street 2:ROOM 1026
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1111
Practice Address - Country:US
Practice Address - Phone:314-977-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist