Basic Information
| Provider Information | |||||||||
| NPI: | 1679613160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FANE | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | KAE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3602 DUFFER RD | ||||||||
| Address2: | |||||||||
| City: | SEBRING | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338721201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8633864809 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6120 US HIGHWAY 27 N | ||||||||
| Address2: | |||||||||
| City: | SEBRING | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338701221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634711223 | ||||||||
| FaxNumber: | 8634712015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 225200000X | PTA 1551 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.