Provider Demographics
NPI:1457580011
Name:JAKUBOWSKI, KIMBERLY TIMBERLAKE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:TIMBERLAKE
Last Name:JAKUBOWSKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JEAN
Other - Last Name:TIMBERLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3639 WHEAT MILLER DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-8006
Mailing Address - Country:US
Mailing Address - Phone:919-605-6677
Mailing Address - Fax:
Practice Address - Street 1:430 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5132
Practice Address - Country:US
Practice Address - Phone:360-491-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist