Provider Demographics
NPI:1841295284
Name:HAIN, KIMBERLY K (PT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:K
Last Name:HAIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2660 W MARKET ST
Mailing Address - Street 2:STE 300
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4206
Mailing Address - Country:US
Mailing Address - Phone:330-869-2635
Mailing Address - Fax:330-869-8315
Practice Address - Street 1:2660 W MARKET ST
Practice Address - Street 2:STE 300
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4206
Practice Address - Country:US
Practice Address - Phone:330-869-2635
Practice Address - Fax:330-869-8315
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT09215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHA4015722Medicare PIN