Provider Demographics
NPI:1679860043
Name:INFANTE, KIMBERLEY SUE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:SUE
Last Name:INFANTE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E. CLIFF DRIVE
Mailing Address - Street 2:SUITE NUMBER 5B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-0001
Mailing Address - Country:US
Mailing Address - Phone:915-259-8399
Mailing Address - Fax:915-259-8364
Practice Address - Street 1:1250 E. CLIFF DRIVE
Practice Address - Street 2:SUITE NUMBER 5B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-0001
Practice Address - Country:US
Practice Address - Phone:915-259-8399
Practice Address - Fax:915-259-8364
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist