Provider Demographics
NPI:1982172698
Name:SCHOENBERG, KIMBERLY (LPTA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SCHOENBERG
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPTA
Mailing Address - Street 1:125 SCOTLAND YARD BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5913
Mailing Address - Country:US
Mailing Address - Phone:904-226-9408
Mailing Address - Fax:
Practice Address - Street 1:12421 SAN JOSE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8662
Practice Address - Country:US
Practice Address - Phone:904-292-0195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19916225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant