Provider Demographics
NPI:1881860898
Name:SCOTT, KIMBERLEY SUE (PT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:SUE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:SUE
Other - Last Name:SONDLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1039 VISOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3326
Mailing Address - Country:US
Mailing Address - Phone:919-724-1892
Mailing Address - Fax:
Practice Address - Street 1:4502 MEDICAL DR # 78229
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-4339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1174181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist