Provider Demographics
NPI:1053536730
Name:DAVIS, KIMBERLY ANNE (MSPT, ATP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSPT, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 REGIONAL DR
Mailing Address - Street 2:SUITE #7
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-8518
Mailing Address - Country:US
Mailing Address - Phone:603-226-2900
Mailing Address - Fax:603-226-2907
Practice Address - Street 1:57 REGIONAL DR
Practice Address - Street 2:SUITE #7
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-8518
Practice Address - Country:US
Practice Address - Phone:603-226-2900
Practice Address - Fax:603-226-2907
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist