Provider Demographics
NPI:1053565887
Name:STRONG, KIMBERLY A (PT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:STRONG
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:8112 ROUTE 12
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304-2122
Mailing Address - Country:US
Mailing Address - Phone:315-896-4330
Mailing Address - Fax:315-896-4331
Practice Address - Street 1:231 WALTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1885
Practice Address - Country:US
Practice Address - Phone:315-478-0380
Practice Address - Fax:315-478-0388
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2013-02-18
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Provider Licenses
StateLicense IDTaxonomies
NY030842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00313539Medicaid
NYAA0172OtherMCR GRP FITNESS FORUM PT
NY01815443Medicaid
NYAA0171OtherMCR GRP # FITNESS FORUM PT
NYAA0171OtherMCR GRP # FITNESS FORUM PT
NY334526Medicare Oscar/Certification