Provider Demographics
NPI:1194818724
Name:COAST, KIMBERLY R (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:COAST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:COAST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:P.O. BOX 191
Mailing Address - Street 2:307 WEST CANAL
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-0191
Mailing Address - Country:US
Mailing Address - Phone:620-855-3693
Mailing Address - Fax:620-855-3411
Practice Address - Street 1:1909 NORTH 14TH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2364
Practice Address - Country:US
Practice Address - Phone:620-338-8633
Practice Address - Fax:620-338-8121
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140904Medicare ID - Type Unspecified
Q12573Medicare UPIN