MEDICARE: KIMBERLY CYR PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	PT06794	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3A685C811	OTHER	LA	MEDICARE GROUP MEMBER PTAN

General Provider Information

NPI Number	:	1801081799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY CYR PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	625 S BURNSIDE AVE
Second Line	:	UNIT #9
City	:	GONZALES
State	:	LA
Zip	:	70737-3400
Country	:	US
Telephone Number	:	225-644-8510
Fax Number	:	225-644-9736

Provider Business Practice Location Address
First Line	:	625 S BURNSIDE AVE
Second Line	:	UNIT #9
City	:	GONZALES
State	:	LA
Zip	:	70737-3400
Country	:	US
Telephone Number	:	225-644-8510
Fax Number	:	225-644-9736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	07/29/2008

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Directions to “ KIMBERLY CYR PHYSICAL THERAPIST” Practice Location

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