Provider Demographics
NPI:1699119107
Name:KINDLE, KIMBERLY ANN (PTA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:KINDLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 PETE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-4728
Mailing Address - Country:US
Mailing Address - Phone:731-968-5470
Mailing Address - Fax:
Practice Address - Street 1:29 N STAR DR
Practice Address - Street 2:SUITE E
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6656
Practice Address - Country:US
Practice Address - Phone:731-410-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3630225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant