Provider Demographics
NPI:1821062761
Name:KIMBEL, SCOTT P (ATC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:P
Last Name:KIMBEL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:PA
Mailing Address - Zip Code:17517-9242
Mailing Address - Country:US
Mailing Address - Phone:717-587-3497
Mailing Address - Fax:717-391-8669
Practice Address - Street 1:109 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:PA
Practice Address - Zip Code:17517-9242
Practice Address - Country:US
Practice Address - Phone:717-587-3497
Practice Address - Fax:717-391-8669
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001657A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer