Provider Demographics
NPI:1518179118
Name:SEIBERT, KIMBERLY M (MSPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:SEIBERT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4372 MINK RD
Mailing Address - Street 2:
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-3203
Mailing Address - Country:US
Mailing Address - Phone:704-777-3029
Mailing Address - Fax:704-366-8369
Practice Address - Street 1:4530 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3716
Practice Address - Country:US
Practice Address - Phone:704-523-1432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist