Provider Demographics
NPI:1417472622
Name:NOWOTNY, KIMBERLY VICTORIA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:VICTORIA
Last Name:NOWOTNY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 LEHMAN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-1218
Mailing Address - Country:US
Mailing Address - Phone:713-582-6235
Mailing Address - Fax:
Practice Address - Street 1:12605 EAST FWY STE 212
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5619
Practice Address - Country:US
Practice Address - Phone:713-453-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12960622251X0800X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic