Provider Demographics
NPI:1134227366
Name:KAPPER, KIMBERLY A (PT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:KAPPER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:CHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:523 E. RAILROAD ST
Mailing Address - Street 2:SUTIE A
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-2286
Mailing Address - Country:US
Mailing Address - Phone:815-786-1888
Mailing Address - Fax:815-786-1811
Practice Address - Street 1:523 E. RAILROAD ST
Practice Address - Street 2:SUTIE A
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-2286
Practice Address - Country:US
Practice Address - Phone:815-786-1888
Practice Address - Fax:815-786-1811
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070006140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
070006140OtherBCBS
P00245558OtherMEDICARE RAILROAD
7959543OtherAETNA
070006140OtherBCBS
P00245558OtherMEDICARE RAILROAD