Provider Demographics
NPI:1487943478
Name:MARQUES, KIMBERLY A (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:MARQUES
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 1:280 BOSTON TPKE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2640
Mailing Address - Country:US
Mailing Address - Phone:508-853-4590
Mailing Address - Fax:
Practice Address - Street 1:120 GOLD STAR BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2825
Practice Address - Country:US
Practice Address - Phone:508-459-5000
Practice Address - Fax:508-459-5900
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist