Provider Demographics
NPI:1376709428
Name:THOMAN, KIMBERLY M (ATC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:M
Last Name:THOMAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 90TH ST
Mailing Address - Street 2:3C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3543
Mailing Address - Country:US
Mailing Address - Phone:631-848-0945
Mailing Address - Fax:
Practice Address - Street 1:7655 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6948
Practice Address - Country:US
Practice Address - Phone:718-897-2228
Practice Address - Fax:718-897-2251
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0014302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer