Provider Demographics
NPI:1154042869
Name:THOMAS, KIMBERLYN RENEA (PT, DPT)
Entity type:Individual
Prefix:
First Name:KIMBERLYN
Middle Name:RENEA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KIMBERLYN
Other - Middle Name:RENEA
Other - Last Name:SKIBBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1501 EISENHOWER AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-0054
Mailing Address - Country:US
Mailing Address - Phone:574-806-4038
Mailing Address - Fax:
Practice Address - Street 1:1501 EISENHOWER AVE APT 104
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-0054
Practice Address - Country:US
Practice Address - Phone:574-806-4038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist