Provider Demographics
NPI:1306987086
Name:WACH, KIMBERLEE A (PT, DPT)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:A
Last Name:WACH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:A
Other - Last Name:ABRIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:288 E 175TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8934
Mailing Address - Country:US
Mailing Address - Phone:317-275-6131
Mailing Address - Fax:
Practice Address - Street 1:288 E 175TH ST STE 200
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8934
Practice Address - Country:US
Practice Address - Phone:317-275-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014937A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFQ483ZMedicare PIN