Provider Demographics
NPI:1508224353
Name:JESPERSEN, KIM (PT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:JESPERSEN
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 1:760 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4056
Mailing Address - Country:US
Mailing Address - Phone:925-743-8905
Mailing Address - Fax:
Practice Address - Street 1:760 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4056
Practice Address - Country:US
Practice Address - Phone:925-743-8905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist