Basic Information
| Provider Information | |||||||||
| NPI: | 1083812713 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORIN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DESKINS | ||||||||
| OtherFirstName: | KIMBERLY | ||||||||
| OtherMiddleName: | E | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 25229 S SUN LAKES BLVD | ||||||||
| Address2: | STE 119 | ||||||||
| City: | SUN LAKES | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852486453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808836734 | ||||||||
| FaxNumber: | 4808958143 | ||||||||
| Practice Location | |||||||||
| Address1: | 1076 W CHANDLER BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852245225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808211997 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 12/09/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8415 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 10129 | CO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.