Provider Demographics
NPI:1972753697
Name:MINEO, KIMBERLY PASCOE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:PASCOE
Last Name:MINEO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 SW HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6721
Mailing Address - Country:US
Mailing Address - Phone:503-293-0161
Mailing Address - Fax:503-452-3200
Practice Address - Street 1:9250 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6721
Practice Address - Country:US
Practice Address - Phone:503-293-0161
Practice Address - Fax:503-452-3200
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist