Provider Demographics
NPI:1881961647
Name:DECARLO, KIMBERLY MARIE
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:DECARLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 STONE DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030
Mailing Address - Country:US
Mailing Address - Phone:513-376-9270
Mailing Address - Fax:513-376-1704
Practice Address - Street 1:1149 STONE DRIVE
Practice Address - Street 2:SUITE 500
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030
Practice Address - Country:US
Practice Address - Phone:513-376-9270
Practice Address - Fax:513-376-1704
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-0008166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist