Provider Demographics
NPI:1154730026
Name:TIMONERA, KIM
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:TIMONERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 HOOVER DIKE RD APT 604
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-2230
Mailing Address - Country:US
Mailing Address - Phone:863-599-1207
Mailing Address - Fax:
Practice Address - Street 1:501 E SUGARLAND HWY
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3210
Practice Address - Country:US
Practice Address - Phone:863-983-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist