Provider Demographics
NPI:1669721114
Name:SWEENOR, KYMBERLIE A (MS RCEP)
Entity type:Individual
Prefix:MS
First Name:KYMBERLIE
Middle Name:A
Last Name:SWEENOR
Suffix:
Gender:F
Credentials:MS RCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:2122 ROUTE 22B
Mailing Address - Street 2:#2
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-3419
Mailing Address - Country:US
Mailing Address - Phone:518-232-6298
Mailing Address - Fax:
Practice Address - Street 1:2122 ROUTE 22B
Practice Address - Street 2:#2
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962-3419
Practice Address - Country:US
Practice Address - Phone:518-232-6298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist