Provider Demographics
NPI:1932588746
Name:PEZO, KIMBERLY DAWN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:PEZO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:500 W GENESEE
Mailing Address - Street 2:TENDERCARE HEALTH CENTER
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734
Mailing Address - Country:US
Mailing Address - Phone:989-652-6101
Mailing Address - Fax:989-652-3787
Practice Address - Street 1:500 W GENESEE
Practice Address - Street 2:TENDERCARE HEALTH CENTER OF FRANKENMUTH
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734
Practice Address - Country:US
Practice Address - Phone:989-652-6101
Practice Address - Fax:989-652-3787
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000332225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant