Provider Demographics
NPI:1952751570
Name:ZIMBELMAN, KELLEY M (DPT)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:M
Last Name:ZIMBELMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:M
Other - Last Name:HENDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1071 W BLUE STARR DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-2868
Mailing Address - Country:US
Mailing Address - Phone:918-342-3800
Mailing Address - Fax:918-342-3900
Practice Address - Street 1:1071 W BLUE STARR DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-2868
Practice Address - Country:US
Practice Address - Phone:918-342-3800
Practice Address - Fax:918-342-3900
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist