Provider Demographics
NPI:1720019813
Name:FAHIE, KIMBERLY (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FAHIE
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 1:99 LANTERN DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-1902
Mailing Address - Country:US
Mailing Address - Phone:267-880-6787
Mailing Address - Fax:267-880-6786
Practice Address - Street 1:99 LANTERN DR
Practice Address - Street 2:SUITE 1
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-1902
Practice Address - Country:US
Practice Address - Phone:267-880-6787
Practice Address - Fax:267-880-6786
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA235198Medicare PIN