Provider Demographics
NPI:1568026557
Name:MCKANDLES MOORE, KIMBERLEA MAE (MPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLEA
Middle Name:MAE
Last Name:MCKANDLES MOORE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-3610
Mailing Address - Country:US
Mailing Address - Phone:806-663-2602
Mailing Address - Fax:806-417-1169
Practice Address - Street 1:1500 N HOBART ST
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-4126
Practice Address - Country:US
Practice Address - Phone:806-663-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty