Provider Demographics
NPI:1689175747
Name:HUBBARD, KIMBERLY (PT, DPT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:KOLB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1009 W VIA DE PALMAS
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7448
Mailing Address - Country:US
Mailing Address - Phone:480-235-1313
Mailing Address - Fax:
Practice Address - Street 1:2225 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4716
Practice Address - Country:US
Practice Address - Phone:480-412-4101
Practice Address - Fax:480-412-8729
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ99672251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic