Provider Demographics
NPI:1750114054
Name:KIMBER, ALYSSA RENEE (DPT)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:RENEE
Last Name:KIMBER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:ALYSSA
Other - Middle Name:RENEE
Other - Last Name:KIMBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:16408 HOLLY CREST LN APT 308
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5119
Mailing Address - Country:US
Mailing Address - Phone:303-956-8482
Mailing Address - Fax:
Practice Address - Street 1:16455 STATESVILLE RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7135
Practice Address - Country:US
Practice Address - Phone:704-863-5804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP23555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist