Provider Demographics
NPI:1437667672
Name:ENGLAND, KIMBERLY L (PTA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:ENGLAND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37910 ALEX DR
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-6511
Mailing Address - Country:US
Mailing Address - Phone:907-252-8085
Mailing Address - Fax:
Practice Address - Street 1:35249 KENAI SPUR HWY STE C
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7623
Practice Address - Country:US
Practice Address - Phone:907-420-0836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK129350225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant