Provider Demographics
NPI:1326167446
Name:REICH, KIMBERLY ANN (PTA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:REICH
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 1:306 BEECH ST
Mailing Address - Street 2:POBOX 72
Mailing Address - City:ELGIN
Mailing Address - State:NE
Mailing Address - Zip Code:68636-4419
Mailing Address - Country:US
Mailing Address - Phone:402-843-6212
Mailing Address - Fax:
Practice Address - Street 1:1500 KOENIGSTEIN AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3664
Practice Address - Country:US
Practice Address - Phone:402-644-7396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE385225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant