Provider Demographics
NPI:1124329826
Name:BELL, KIMBERLEY ANTOSE (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANTOSE
Last Name:BELL
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 1:425 BONAIR ST
Mailing Address - Street 2:#2
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5917
Mailing Address - Country:US
Mailing Address - Phone:858-997-6002
Mailing Address - Fax:
Practice Address - Street 1:425 BONAIR ST
Practice Address - Street 2:#2
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5917
Practice Address - Country:US
Practice Address - Phone:858-997-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327522251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics