Provider Demographics
NPI:1255467254
Name:ERISMAN, KIMBERLY MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:ERISMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MARIE
Other - Last Name:ERISMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT
Mailing Address - Street 1:7279 W 105TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-2515
Mailing Address - Country:US
Mailing Address - Phone:913-642-7746
Mailing Address - Fax:913-642-7745
Practice Address - Street 1:7279 W 105TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-2515
Practice Address - Country:US
Practice Address - Phone:913-642-7746
Practice Address - Fax:913-642-7745
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11033242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic