Provider Demographics
NPI:1679683395
Name:SUAREZ-TERRELL, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SUAREZ-TERRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15310 AMBERLY DR STE 155
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1645
Mailing Address - Country:US
Mailing Address - Phone:813-971-9351
Mailing Address - Fax:813-977-7671
Practice Address - Street 1:15310 AMBERLY DR STE 155
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1645
Practice Address - Country:US
Practice Address - Phone:813-971-9351
Practice Address - Fax:813-977-7671
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 16554OtherLICENSE #