Provider Demographics
NPI:1275788390
Name:MUNOZ, KIMBERLY A (3360 PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:3360 PT
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:3360 PT
Mailing Address - Street 1:1374 W FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:RIO RICO
Mailing Address - State:AZ
Mailing Address - Zip Code:85648-6238
Mailing Address - Country:US
Mailing Address - Phone:520-375-8291
Mailing Address - Fax:520-377-0680
Practice Address - Street 1:1374 W. FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:RIO RICO
Practice Address - State:AZ
Practice Address - Zip Code:85648
Practice Address - Country:US
Practice Address - Phone:520-375-8291
Practice Address - Fax:520-377-0680
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist