Provider Demographics
NPI:1669894853
Name:VANFLEET, KIM (PTA/ATC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:VANFLEET
Suffix:
Gender:F
Credentials:PTA/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 FALMOUTH RD
Mailing Address - Street 2:1600 FALMOUTH ROAD
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-2939
Mailing Address - Country:US
Mailing Address - Phone:508-775-0060
Mailing Address - Fax:508-775-3667
Practice Address - Street 1:1600 FALMOUTH RD
Practice Address - Street 2:1600 FALMOUTH ROAD
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-2939
Practice Address - Country:US
Practice Address - Phone:508-775-0060
Practice Address - Fax:508-775-3667
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8754225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant