Provider Demographics
NPI:1982760997
Name:WHITE, KIMBERLY KELLY (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KELLY
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GREENOUGH RD
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2724
Mailing Address - Country:US
Mailing Address - Phone:603-382-6119
Mailing Address - Fax:603-881-7198
Practice Address - Street 1:8 COMMERCE DRIVE
Practice Address - Street 2:
Practice Address - City:ATKINSON
Practice Address - State:NH
Practice Address - Zip Code:03038
Practice Address - Country:US
Practice Address - Phone:603-893-1299
Practice Address - Fax:603-893-5401
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0805370Y0NH01OtherBCBS
612418OtherTUFTS
34178OtherCIGNA
NH020347939OtherCOMM TAX ID
AA16390OtherHARVARD PILGRIM HEALTHCAR