Provider Demographics
NPI:1568961605
Name:RICHARDS-PASSINI, KIM STYBA (DPT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:STYBA
Last Name:RICHARDS-PASSINI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 GOOSE LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4706
Mailing Address - Country:US
Mailing Address - Phone:515-450-7521
Mailing Address - Fax:
Practice Address - Street 1:2400 N DODGE ST STE B
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-8304
Practice Address - Country:US
Practice Address - Phone:319-246-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist