Provider Demographics
NPI:1770779951
Name:BRUHN, KIMBERLY MICHELLE (PT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:BRUHN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:NOCONA
Mailing Address - State:TX
Mailing Address - Zip Code:76255-3010
Mailing Address - Country:US
Mailing Address - Phone:940-825-5069
Mailing Address - Fax:
Practice Address - Street 1:100 PARK RD
Practice Address - Street 2:
Practice Address - City:NOCONA
Practice Address - State:TX
Practice Address - Zip Code:76255-3616
Practice Address - Country:US
Practice Address - Phone:940-825-7246
Practice Address - Fax:940-825-3323
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1108082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist