Provider Demographics
NPI:1396177036
Name:GREINER, KIMBERLI CHRISTINE (DPT)
Entity type:Individual
Prefix:
First Name:KIMBERLI
Middle Name:CHRISTINE
Last Name:GREINER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KIMBERLI
Other - Middle Name:CHRISTINE
Other - Last Name:DARNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 EDMUNDSON PL
Mailing Address - Street 2:SUITE 500
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4658
Mailing Address - Country:US
Mailing Address - Phone:712-323-5333
Mailing Address - Fax:712-323-3252
Practice Address - Street 1:1 EDMUNDSON PL
Practice Address - Street 2:SUITE 500
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4658
Practice Address - Country:US
Practice Address - Phone:712-323-5333
Practice Address - Fax:712-323-3252
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE3248Medicaid
NE3248Medicaid
NE3248Medicare PIN