Provider Demographics
NPI:1487903357
Name:LONG, KIMBRI RENEE' (PT, DPT)
Entity type:Individual
Prefix:
First Name:KIMBRI
Middle Name:RENEE'
Last Name:LONG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 VISTA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2139
Mailing Address - Country:US
Mailing Address - Phone:713-910-5437
Mailing Address - Fax:713-910-5445
Practice Address - Street 1:3801 VISTA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2159
Practice Address - Country:US
Practice Address - Phone:713-910-5437
Practice Address - Fax:713-910-5445
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1224596174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist