Provider Demographics
NPI:1619085933
Name:NURENBERG, KIM DANIELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:DANIELLE
Last Name:NURENBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16549 79TH TER N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7682
Mailing Address - Country:US
Mailing Address - Phone:561-575-3326
Mailing Address - Fax:
Practice Address - Street 1:2141 ALTERNATE A1A SOUTH, STE 300
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4063
Practice Address - Country:US
Practice Address - Phone:561-743-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT5373OtherLICENSE #