Provider Demographics
NPI:1659438927
Name:HUTTON, KIMBERLY N (PTA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:N
Last Name:HUTTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:N
Other - Last Name:OSLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1919 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-9756
Mailing Address - Country:US
Mailing Address - Phone:716-754-8299
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-3224
Practice Address - Fax:716-898-3259
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003453225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant