Provider Demographics
NPI:1104883230
Name:STOECKEL, KIMBERLY ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:STOECKEL
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 1:2028 NW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4116
Mailing Address - Country:US
Mailing Address - Phone:719-425-6326
Mailing Address - Fax:
Practice Address - Street 1:50 FOREST FALLS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6937
Practice Address - Country:US
Practice Address - Phone:207-846-8725
Practice Address - Fax:207-846-8728
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3135225100000X
IA092323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2756063001OtherCIGNA
ME431552002Medicaid
ME626281OtherHARVARD PILGRIM
ME100262OtherANTHEM BCBS