Provider Demographics
NPI:1992877930
Name:BROWN, KIMBERLY JOY (MSPT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOY
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JOY
Other - Last Name:DEHNEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:6817 CAMINO DE AMIGOS
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4561
Mailing Address - Country:US
Mailing Address - Phone:760-908-8175
Mailing Address - Fax:760-891-0284
Practice Address - Street 1:533 2ND ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3558
Practice Address - Country:US
Practice Address - Phone:760-814-4938
Practice Address - Fax:888-773-3272
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1951225100000X
CA40055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0227536OtherHMSA
HI50076101Medicaid
HI50076101Medicaid