Provider Demographics
NPI:1437436946
Name:TETER, KIMBERLY DEE (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DEE
Last Name:TETER
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 1:18214 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3515
Mailing Address - Country:US
Mailing Address - Phone:281-433-9654
Mailing Address - Fax:
Practice Address - Street 1:18214 HERITAGE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3515
Practice Address - Country:US
Practice Address - Phone:281-433-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist