Provider Demographics
NPI:1649670530
Name:GRANDE, KIMBERLY (DPT, ATC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GRANDE
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2655
Mailing Address - Country:US
Mailing Address - Phone:609-276-0538
Mailing Address - Fax:848-900-8007
Practice Address - Street 1:213 19TH AVE
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2655
Practice Address - Country:US
Practice Address - Phone:609-276-0538
Practice Address - Fax:848-900-8007
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2251P0200X
GAUNKNOWN2251P0200X
FL296042251X0800X
NJ40QA01590300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic