Basic Information
| Provider Information | |||||||||
| NPI: | 1427386549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUJAWA | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14287 N 87TH ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852603698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805514966 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9097 E DESERT COVE AVE | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852606279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808604298 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2009 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1031888 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | LPT-30268 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 456908 | 05 | AZ | MEDICAID |