Provider Demographics
NPI:1538706387
Name:DOS SANTOS, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:DOS SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 RIVERVIEW BND S UNIT 811
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-6584
Mailing Address - Country:US
Mailing Address - Phone:386-315-9455
Mailing Address - Fax:
Practice Address - Street 1:80 RIVERVIEW BND S UNIT 811
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-6584
Practice Address - Country:US
Practice Address - Phone:386-222-3224
Practice Address - Fax:386-382-3984
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist