Basic Information
| Provider Information | |||||||||
| NPI: | 1972753697 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINEO | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | PASCOE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9250 SW HALL BLVD | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972236721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032930161 | ||||||||
| FaxNumber: | 5034523200 | ||||||||
| Practice Location | |||||||||
| Address1: | 9250 SW HALL BLVD | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972236721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032930161 | ||||||||
| FaxNumber: | 5034523200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2008 | ||||||||
| LastUpdateDate: | 10/10/2012 | ||||||||
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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 | 5699 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.