Provider Demographics
NPI:1831295336
Name:MICHALSEN, KIMBERLY S (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:MICHALSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:PYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-8930
Mailing Address - Fax:423-285-6647
Practice Address - Street 1:112 NEWPORT TOWNE CTR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-7360
Practice Address - Country:US
Practice Address - Phone:423-623-2890
Practice Address - Fax:423-623-2924
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-005854225100000X
TNPT7810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P83546Medicare UPIN
ILL97263Medicare ID - Type Unspecified