Provider Demographics
NPI:1154593408
Name:HUCK, KIMBERLY (DPT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:HUCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 CLARK RD
Mailing Address - Street 2:STE 106
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1197
Mailing Address - Country:US
Mailing Address - Phone:734-528-9760
Mailing Address - Fax:734-829-0173
Practice Address - Street 1:203 S ZEEB RD
Practice Address - Street 2:STE 205
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-8326
Practice Address - Country:US
Practice Address - Phone:734-929-6400
Practice Address - Fax:734-929-6401
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist