Provider Demographics
NPI:1295987618
Name:SCULLION, KIMBERLY DENEEN (MA)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DENEEN
Last Name:SCULLION
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 ARIZONA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3304
Mailing Address - Country:US
Mailing Address - Phone:505-379-5546
Mailing Address - Fax:505-821-7671
Practice Address - Street 1:2920 ARIZONA ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3304
Practice Address - Country:US
Practice Address - Phone:505-379-5546
Practice Address - Fax:505-821-7671
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist