Provider Demographics
NPI:1568707743
Name:KIMURA, ZORRE ZENO (PT)
Entity Type:Individual
Prefix:MR
First Name:ZORRE
Middle Name:ZENO
Last Name:KIMURA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10211 WORTHINGTON LN
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8549
Mailing Address - Country:US
Mailing Address - Phone:502-641-1214
Mailing Address - Fax:
Practice Address - Street 1:10211 WORTHINGTON LANE
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059
Practice Address - Country:US
Practice Address - Phone:502-641-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY001116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist