Provider Demographics
NPI:1710313036
Name:BLACKABY, KIMBERLY SARAH (DPT)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SARAH
Last Name:BLACKABY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6507
Mailing Address - Country:US
Mailing Address - Phone:610-868-2211
Mailing Address - Fax:610-868-8871
Practice Address - Street 1:41 E ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6507
Practice Address - Country:US
Practice Address - Phone:610-868-2211
Practice Address - Fax:610-868-8871
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist