Provider Demographics
NPI:1326027905
Name:MARSH, KIMBERLY O (PT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:O
Last Name:MARSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3054 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2755
Mailing Address - Country:US
Mailing Address - Phone:814-234-6023
Mailing Address - Fax:814-234-1439
Practice Address - Street 1:3054 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2755
Practice Address - Country:US
Practice Address - Phone:814-234-6023
Practice Address - Fax:814-234-1439
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH29812251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5984520OtherAETNA PROVIDER #
AL510-77696OtherBLUE CROSS PROVIDER NUMBE
ALONO4081OtherUHC PROVIDER #
AL890004630Medicaid
AL04080OtherCRS PROVIDER #
ALU409201OtherMAMSI PROVIDER #