Provider Demographics
NPI:1841483831
Name:STOLTZFUS, KIMBERLY RENEE (DPT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RENEE
Last Name:STOLTZFUS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-5017
Mailing Address - Country:US
Mailing Address - Phone:843-761-1482
Mailing Address - Fax:843-761-1483
Practice Address - Street 1:2061 HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-5017
Practice Address - Country:US
Practice Address - Phone:843-761-1482
Practice Address - Fax:843-761-1483
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018844225100000X
SC8516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
306078OtherUNISON
PA1979915OtherFREEDOM BLUE
PA50087547OtherCAPITAL BLUE CROSS
PA30068871OtherKEYSTONE MERCY
PA101978171-0002Medicaid
000000287446OtherAMERICHOICE
PA1979915OtherHIGHMARK PA BLUE SHIELD
PA2857469000OtherIBC
PA177761VLZMedicare PIN
000000287446OtherAMERICHOICE
PA2857469000OtherIBC