Basic Information
| Provider Information | |||||||||
| NPI: | 1386882918 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURKA | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10325 E RIGGS RD | ||||||||
| Address2: | 102 | ||||||||
| City: | SUN LAKES | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852487623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808027081 | ||||||||
| FaxNumber: | 4808028492 | ||||||||
| Practice Location | |||||||||
| Address1: | 10325 E RIGGS RD | ||||||||
| Address2: | 102 | ||||||||
| City: | SUN LAKES | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852487623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808027081 | ||||||||
| FaxNumber: | 4808028492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2009 | ||||||||
| LastUpdateDate: | 02/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2935 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.