Provider Demographics
NPI:1013984830
Name:HILDITCH, KIMBERLY DIANE (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DIANE
Last Name:HILDITCH
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 1:14418 W MEEKER BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-5290
Mailing Address - Country:US
Mailing Address - Phone:623-546-6712
Mailing Address - Fax:623-546-6739
Practice Address - Street 1:14418 W MEEKER BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5290
Practice Address - Country:US
Practice Address - Phone:623-546-6712
Practice Address - Fax:623-546-6739
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
326111OtherAHCCCS
AZ2Z2293OtherHEALTH NET
AZ719049OtherAHCCCS
AZP00121650OtherRAILROAD MEDICARE
AZP02039084OtherRAILROAD MEDICARE
AZ161706OtherASH
AZ4428261OtherAETNA
AZ326111OtherMEDICAID