Provider Demographics
NPI:1629576830
Name:NURMI, KIMBERLY H (PTA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:H
Last Name:NURMI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 SE GRANT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5444
Mailing Address - Country:US
Mailing Address - Phone:503-231-4359
Mailing Address - Fax:
Practice Address - Street 1:420 NE MASON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3479
Practice Address - Country:US
Practice Address - Phone:503-936-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07063225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant