Provider Demographics
NPI:1346088556
Name:ESPARZA, KIMBERLY PAIGE (DPT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:PAIGE
Last Name:ESPARZA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:PAIGE
Other - Last Name:DECOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 COMPASS RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:54 BATTLEFIELD CIR
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-5110
Practice Address - Country:US
Practice Address - Phone:706-445-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-20
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15612225100000X
GACP032841T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist