Provider Demographics
NPI:1669417226
Name:LIERMAN, KIMBERLY MCGOUGH (PT,ATC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MCGOUGH
Last Name:LIERMAN
Suffix:
Gender:F
Credentials:PT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 SE GAIL CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-5261
Mailing Address - Country:US
Mailing Address - Phone:503-693-9923
Mailing Address - Fax:
Practice Address - Street 1:626 SE 9TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4600
Practice Address - Country:US
Practice Address - Phone:503-681-4238
Practice Address - Fax:503-681-4239
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38412251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports