Provider Demographics
NPI:1508901331
Name:BROWN, KIMBERLY ANNE (PT, MA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, MA
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MA
Mailing Address - Street 1:7009 W PONTIAC DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9448
Mailing Address - Country:US
Mailing Address - Phone:623-910-2398
Mailing Address - Fax:623-561-9591
Practice Address - Street 1:3348 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-2416
Practice Address - Country:US
Practice Address - Phone:602-455-6700
Practice Address - Fax:602-278-1693
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ417817OtherAHCCCS