Provider Demographics
NPI:1548220411
Name:TALBOT, KIMBERLY E (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:E
Last Name:TALBOT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:E
Other - Last Name:OBERPRILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1000 E 1ST ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:800-225-1321
Mailing Address - Fax:218-722-6515
Practice Address - Street 1:1000 E 1ST ST
Practice Address - Street 2:SUITE 404
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-722-5513
Practice Address - Fax:218-722-6515
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7679225100000X
WI11431-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1548220411Medicaid
P00870865Medicare PIN
800500011Medicare PIN