Provider Demographics
NPI:1124872023
Name:MORRILL, KIMBERLY (MA, R-DMT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MORRILL
Suffix:
Gender:X
Credentials:MA, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3094
Mailing Address - Country:US
Mailing Address - Phone:215-320-2601
Mailing Address - Fax:
Practice Address - Street 1:416 QUEEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-3094
Practice Address - Country:US
Practice Address - Phone:215-320-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist