Provider Demographics
NPI:1740424886
Name:HOUSE, KIMBERLY CARVER (PT)
Entity Type:Individual
Prefix:PROF
First Name:KIMBERLY
Middle Name:CARVER
Last Name:HOUSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 N SAM HOUSTON PKWY W STE 240
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086-1466
Mailing Address - Country:US
Mailing Address - Phone:832-968-7155
Mailing Address - Fax:713-383-9795
Practice Address - Street 1:17937 INTERSTATE 45 S
Practice Address - Street 2:SUITE 143
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8706
Practice Address - Country:US
Practice Address - Phone:936-273-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1256736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist