Provider Demographics
NPI:1497219869
Name:ADAMS, KIMBERLEE P (PTA)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:P
Last Name:ADAMS
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 1:16727 FM 362 RD
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-7916
Mailing Address - Country:US
Mailing Address - Phone:801-648-2715
Mailing Address - Fax:
Practice Address - Street 1:23553 W FERNHURST DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0686
Practice Address - Country:US
Practice Address - Phone:281-394-1300
Practice Address - Fax:281-394-1301
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2103018225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant