Provider Demographics
NPI:1013336650
Name:KIMBERLY, ADAM (PT,DPT,OCS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:KIMBERLY
Suffix:
Gender:M
Credentials:PT,DPT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 COOPER FOSTER PARK RD W
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4131
Mailing Address - Country:US
Mailing Address - Phone:440-204-7850
Mailing Address - Fax:
Practice Address - Street 1:5800 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4131
Practice Address - Country:US
Practice Address - Phone:440-204-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0125042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic