Provider Demographics
NPI:1811057698
Name:WOODARD, KIMBERLI (DPT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLI
Middle Name:
Last Name:WOODARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:KIMBERLI
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 493396
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-3396
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 S LASSEN ST
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-3009
Practice Address - Country:US
Practice Address - Phone:530-934-2870
Practice Address - Fax:530-934-2867
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist