Provider Demographics
NPI:1306140066
Name:MIGEL, KIMMERY (DPT)
Entity type:Individual
Prefix:
First Name:KIMMERY
Middle Name:
Last Name:MIGEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KIMMERY
Other - Middle Name:
Other - Last Name:GEANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1234 SUMMER ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5558
Mailing Address - Country:US
Mailing Address - Phone:203-359-8326
Mailing Address - Fax:203-352-1912
Practice Address - Street 1:1234 SUMMER ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5558
Practice Address - Country:US
Practice Address - Phone:203-359-8326
Practice Address - Fax:203-352-1912
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400044467Medicare PIN