Provider Demographics
NPI:1023441953
Name:KIMBLE, ALLEN Y III (PTA)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:Y
Last Name:KIMBLE
Suffix:III
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 WATERBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9241
Mailing Address - Country:US
Mailing Address - Phone:407-892-8823
Mailing Address - Fax:
Practice Address - Street 1:10395 NARCOOSSEE RD
Practice Address - Street 2:STE E
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6939
Practice Address - Country:US
Practice Address - Phone:407-730-3244
Practice Address - Fax:407-730-3246
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 24215225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant