Provider Demographics
NPI:1831689207
Name:KLIKUS, KIMBERLY M (PTA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:KLIKUS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 LINCOLN HWY STE 1100
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3979
Mailing Address - Country:US
Mailing Address - Phone:732-545-7474
Mailing Address - Fax:732-545-2880
Practice Address - Street 1:1527 LINCOLN HWY STE 1100
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3979
Practice Address - Country:US
Practice Address - Phone:732-545-7474
Practice Address - Fax:732-545-2880
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2024-10-02
Deactivation Date:2022-04-04
Deactivation Code:
Reactivation Date:2024-10-02
Provider Licenses
StateLicense IDTaxonomies
PA40QB00348900225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty