Provider Demographics
NPI:1235290529
Name:DEERING, KIMBERLEY KIEL (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:KIEL
Last Name:DEERING
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:PO BOX 3278
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86402-3278
Mailing Address - Country:US
Mailing Address - Phone:928-753-4263
Mailing Address - Fax:928-753-1173
Practice Address - Street 1:1841 E MORROW AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3026
Practice Address - Country:US
Practice Address - Phone:928-753-4263
Practice Address - Fax:928-753-1173
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0292050OtherBCBS
AZ782567Medicaid
AZZ28449Medicare ID - Type Unspecified