Provider Demographics
NPI:1114710654
Name:TIMPONE, KERSTIN
Entity type:Individual
Prefix:
First Name:KERSTIN
Middle Name:
Last Name:TIMPONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 LIVE OAK RD
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-6900
Mailing Address - Country:US
Mailing Address - Phone:573-808-2160
Mailing Address - Fax:
Practice Address - Street 1:711 W BAY AREA BLVD STE 608
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4042
Practice Address - Country:US
Practice Address - Phone:281-338-1273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1406717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist