Provider Demographics
NPI:1689950255
Name:CINELLI-HAMPTON, KIMBERLY PAIGE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:PAIGE
Last Name:CINELLI-HAMPTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 HOLLOW VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:CASEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62232-2838
Mailing Address - Country:US
Mailing Address - Phone:618-223-1301
Mailing Address - Fax:
Practice Address - Street 1:1021 HOLLOW VALLEY CT
Practice Address - Street 2:
Practice Address - City:CASEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62232-2838
Practice Address - Country:US
Practice Address - Phone:618-223-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.016781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist