Provider Demographics
NPI:1629382569
Name:RODRIGUEZ, KIMBERLY KENNA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KENNA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:KENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:117 CANYON RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-7027
Mailing Address - Country:US
Mailing Address - Phone:540-327-5186
Mailing Address - Fax:
Practice Address - Street 1:322 N BUCKMARSH ST STE A
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-1024
Practice Address - Country:US
Practice Address - Phone:540-955-1837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052064682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic