Provider Demographics
NPI:1346419280
Name:HUTCHINSON, KIMBERLY K (RPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-1002
Mailing Address - Country:US
Mailing Address - Phone:619-474-5916
Mailing Address - Fax:619-474-8662
Practice Address - Street 1:412 W 8TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-1002
Practice Address - Country:US
Practice Address - Phone:619-474-5916
Practice Address - Fax:619-474-8662
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10199AMedicare UPIN