Provider Demographics
NPI:1124497136
Name:LAPRADE, KIMBERLY LYNN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNN
Last Name:LAPRADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DIMASSA DR
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2121
Mailing Address - Country:US
Mailing Address - Phone:978-833-7578
Mailing Address - Fax:
Practice Address - Street 1:265 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-2083
Practice Address - Country:US
Practice Address - Phone:508-394-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-20
Last Update Date:2015-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8990225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant