Provider Demographics
NPI:1619151917
Name:KIMBROUGH, KRISTIN L (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:KIMBROUGH
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 1:2783 NORTH SHILOH DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6984
Mailing Address - Country:US
Mailing Address - Phone:479-571-1305
Mailing Address - Fax:479-571-1310
Practice Address - Street 1:2783 NORTH SHILOH DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-6984
Practice Address - Country:US
Practice Address - Phone:479-571-1305
Practice Address - Fax:479-571-1310
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 3026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist