Provider Demographics
NPI:1780713628
Name:VAN LIEMPD, KIMBERLY M (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:VAN LIEMPD
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 1:801 N ORANGE AVE
Mailing Address - Street 2:610
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1026
Mailing Address - Country:US
Mailing Address - Phone:407-263-7155
Mailing Address - Fax:407-263-7441
Practice Address - Street 1:401 VENTURE DR
Practice Address - Street 2:SUITE 3 C
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3478
Practice Address - Country:US
Practice Address - Phone:407-386-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q99921Medicare PIN
NYQ3W9Y1Medicare PIN