Provider Demographics
NPI:1386877611
Name:DAVITT, KIMBERLY JILL (MA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JILL
Last Name:DAVITT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S OCEAN DR
Mailing Address - Street 2:PH 606
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-6115
Mailing Address - Country:US
Mailing Address - Phone:561-445-9902
Mailing Address - Fax:
Practice Address - Street 1:1645 SE 3RD CT
Practice Address - Street 2:SUITE 100
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4465
Practice Address - Country:US
Practice Address - Phone:561-445-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40865172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist