Provider Demographics
NPI:1760593982
Name:KISH, KIMBERLY (MSPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KISH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 CREEDMOOR RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1684
Mailing Address - Country:US
Mailing Address - Phone:919-848-3333
Mailing Address - Fax:919-848-3393
Practice Address - Street 1:6500 CREEDMOOR RD
Practice Address - Street 2:SUITE 208
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-3697
Practice Address - Country:US
Practice Address - Phone:919-676-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist