Provider Demographics
NPI:1366710386
Name:KIMBRELL, REBECCA BULLION (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:BULLION
Last Name:KIMBRELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 FAIRMONT PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3335
Mailing Address - Country:US
Mailing Address - Phone:281-998-8600
Mailing Address - Fax:281-998-8604
Practice Address - Street 1:4600 FAIRMONT PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3335
Practice Address - Country:US
Practice Address - Phone:281-998-8600
Practice Address - Fax:281-998-8604
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1210620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist