Provider Demographics
NPI:1053549154
Name:WAH, KIMBERLY SUE (DPT)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:SUE
Last Name:WAH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11947 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7619
Mailing Address - Country:US
Mailing Address - Phone:561-204-2213
Mailing Address - Fax:561-204-2218
Practice Address - Street 1:11947 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411
Practice Address - Country:US
Practice Address - Phone:561-204-2213
Practice Address - Fax:561-204-2218
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist