Provider Demographics
NPI:1780859090
Name:VORHOLT, KIMBERLEY JO (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:JO
Last Name:VORHOLT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:JO
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-0450
Mailing Address - Country:US
Mailing Address - Phone:304-760-6300
Mailing Address - Fax:304-201-5123
Practice Address - Street 1:179 STATION PLACE DRIVE
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8749
Practice Address - Country:US
Practice Address - Phone:304-760-6300
Practice Address - Fax:304-201-5123
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist