Provider Demographics
NPI:1831499094
Name:DONAHUE, KIMBERLY A (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:KUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4180 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-6106
Mailing Address - Country:US
Mailing Address - Phone:651-241-1455
Mailing Address - Fax:
Practice Address - Street 1:4180 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-6106
Practice Address - Country:US
Practice Address - Phone:651-241-1455
Practice Address - Fax:651-241-1456
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10701225100000X
MN92492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCP1303OtherMEDICARE CMS