Provider Demographics
NPI:1457453128
Name:KIMBALL, JENNIFER CHRISTINE (PT)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:KIMBALL
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 1:3933 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2423
Mailing Address - Country:US
Mailing Address - Phone:510-531-6956
Mailing Address - Fax:
Practice Address - Street 1:19845 LAKE CHABOT RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4055
Practice Address - Country:US
Practice Address - Phone:510-538-9558
Practice Address - Fax:510-538-7017
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist