Provider Demographics
NPI:1801863238
Name:KESTER, JIM W (PT)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:W
Last Name:KESTER
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:4715 N 32ND ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3300
Mailing Address - Country:US
Mailing Address - Phone:480-689-5520
Mailing Address - Fax:480-706-7409
Practice Address - Street 1:13933 W GRAND AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2435
Practice Address - Country:US
Practice Address - Phone:623-474-3952
Practice Address - Fax:623-474-3953
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2013-10-18
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Provider Licenses
StateLicense IDTaxonomies
AZ5920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3Z3987OtherHEALTHNET
AZ723660Medicaid
AZ3Z3987OtherHEALTHNET
AZ723660Medicaid