Provider Demographics
NPI:1407076896
Name:BIANCHINI, KIMBERLY LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LOUISE
Last Name:BIANCHINI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7205
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-0205
Mailing Address - Country:US
Mailing Address - Phone:203-758-5040
Mailing Address - Fax:203-758-5042
Practice Address - Street 1:44 WATERBURY RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1242
Practice Address - Country:US
Practice Address - Phone:203-758-5040
Practice Address - Fax:203-758-5042
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4334225100000X
CT8237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist