Provider Demographics
NPI:1487802500
Name:FRICK, KIMBERLY JILL (PT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JILL
Last Name:FRICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025
Mailing Address - Country:US
Mailing Address - Phone:270-527-0147
Mailing Address - Fax:270-527-0147
Practice Address - Street 1:2607 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025
Practice Address - Country:US
Practice Address - Phone:270-527-0147
Practice Address - Fax:270-527-0147
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist