Provider Demographics
NPI:1316129166
Name:GROLEAU, KIMBERLY A (PT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:GROLEAU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:916-887-7398
Mailing Address - Fax:847-956-5420
Practice Address - Street 1:568 N SUNRISE AVE., STE. 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3097
Practice Address - Country:US
Practice Address - Phone:916-865-1100
Practice Address - Fax:916-865-1105
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15755225100000X
FLPT3467225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist