Provider Demographics
NPI:1407802614
Name:AUL, KIMBERLY F (MSPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:F
Last Name:AUL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 OLD REDWOOD HWY
Mailing Address - Street 2:MOB 5, SUITE 154
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1719
Mailing Address - Country:US
Mailing Address - Phone:707-556-5858
Mailing Address - Fax:707-546-1897
Practice Address - Street 1:3975 OLD REDWOOD HWY
Practice Address - Street 2:MOB 5, SUITE 154
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1719
Practice Address - Country:US
Practice Address - Phone:707-556-5858
Practice Address - Fax:707-546-1897
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5073225100000X
CAPT36898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT36898OtherLICENSE