Provider Demographics
NPI:1427386549
Name:KUJAWA, KIMBERLY C (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:C
Last Name:KUJAWA
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 1:14287 N 87TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3698
Mailing Address - Country:US
Mailing Address - Phone:480-551-4966
Mailing Address - Fax:
Practice Address - Street 1:9097 E DESERT COVE AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6279
Practice Address - Country:US
Practice Address - Phone:480-860-4298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1031888225100000X
AZLPT-30268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ456908Medicaid