Provider Demographics
NPI:1306184049
Name:HAUGHT, KIMBERLY ALICIA (PTA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALICIA
Last Name:HAUGHT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-1022
Mailing Address - Country:US
Mailing Address - Phone:484-764-6943
Mailing Address - Fax:
Practice Address - Street 1:1011 W PENN AVE
Practice Address - Street 2:
Practice Address - City:ROBESONIA
Practice Address - State:PA
Practice Address - Zip Code:19551-9550
Practice Address - Country:US
Practice Address - Phone:610-589-2263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI001357225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant