Provider Demographics
NPI:1760681878
Name:LINK, KIMBERLY (DPT)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:
Last Name:LINK
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 1:3805 CUTSHAW AVE
Mailing Address - Street 2:SUITE 299
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3943
Mailing Address - Country:US
Mailing Address - Phone:804-340-1193
Mailing Address - Fax:
Practice Address - Street 1:3805 CUTSHAW AVE
Practice Address - Street 2:SUITE 299
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3943
Practice Address - Country:US
Practice Address - Phone:804-340-1193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1760681878Medicaid
VA014413R75Medicare PIN
C09247Medicare PIN
VA1760681878Medicaid
VA014412A47Medicare PIN