Provider Demographics
NPI:1366651499
Name:KIMBRELL, JAMES KYLE
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KYLE
Last Name:KIMBRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1896 RIDGEGATE LN APT G
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0828
Mailing Address - Country:US
Mailing Address - Phone:805-484-2026
Mailing Address - Fax:
Practice Address - Street 1:231 CAMARILLO RANCH RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5082
Practice Address - Country:US
Practice Address - Phone:805-484-2026
Practice Address - Fax:805-389-1196
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 29472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist