Provider Demographics
NPI:1740250281
Name:KIMBALL, AMY LYNN (PT, ATC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:KIMBALL
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 1:1717 BOYSON RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2313
Mailing Address - Country:US
Mailing Address - Phone:319-200-2004
Mailing Address - Fax:319-200-2009
Practice Address - Street 1:1717 BOYSON RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2313
Practice Address - Country:US
Practice Address - Phone:319-200-2004
Practice Address - Fax:319-200-2009
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA029052251S0007X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA02905OtherIOWA PT LICENSE