Provider Demographics
NPI:1013154186
Name:HARTT, KIMBERLY L (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:HARTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 2273
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91610-0273
Mailing Address - Country:US
Mailing Address - Phone:818-308-7141
Mailing Address - Fax:818-301-2660
Practice Address - Street 1:12626 RIVERSIDE DRIVE STE. 512
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3460
Practice Address - Country:US
Practice Address - Phone:818-308-7141
Practice Address - Fax:818-301-2660
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25967225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist