Provider Demographics
NPI:1962819359
Name:BAASCH, KIMBERLY ELISE NILSEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELISE NILSEN
Last Name:BAASCH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 DUNDAS DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8502
Mailing Address - Country:US
Mailing Address - Phone:904-757-1782
Mailing Address - Fax:
Practice Address - Street 1:320 DUNDAS DR
Practice Address - Street 2:SUITE 8
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8502
Practice Address - Country:US
Practice Address - Phone:904-757-1782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist