Provider Demographics
NPI:1285783837
Name:MINISCALCO, KIMBERLY B (PT, MHS)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:B
Last Name:MINISCALCO
Suffix:
Gender:F
Credentials:PT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2902 N RACINE AVE
Mailing Address - Street 2:#1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4224
Mailing Address - Country:US
Mailing Address - Phone:312-339-2193
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 1006
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-563-2454
Practice Address - Fax:312-563-2222
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70007852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist