Provider Demographics
NPI:1356770945
Name:TYBOROWSKI, KIMBERLY ANNE (PT, DPT, ATC, CIDN)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANNE
Last Name:TYBOROWSKI
Suffix:
Gender:F
Credentials:PT, DPT, ATC, CIDN
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:STONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC
Mailing Address - Street 1:17453 JEFFERSON DAVIS HWY.
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026
Mailing Address - Country:US
Mailing Address - Phone:703-221-3913
Mailing Address - Fax:703-221-3203
Practice Address - Street 1:17453 JEFFERSON DAVIS HWY.
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026
Practice Address - Country:US
Practice Address - Phone:703-221-3913
Practice Address - Fax:703-221-3203
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20000017772255A2300X
VA2305207469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer