Provider Demographics
NPI:1275295404
Name:TONICK, KIMBERLY LYN (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYN
Last Name:TONICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 COIT RD STE B
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3773
Mailing Address - Country:US
Mailing Address - Phone:972-599-9191
Mailing Address - Fax:972-599-2323
Practice Address - Street 1:2301 COIT RD STE B
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-3773
Practice Address - Country:US
Practice Address - Phone:972-599-9191
Practice Address - Fax:972-599-2323
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist