Healthcare Provider Details

I. General information

NPI: 1821072711
Provider Name (Legal Business Name): KIMBERLY A MUSA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/03/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 475 BOX 1883
FPO AP
96350
US

IV. Provider business mailing address

PSC 475 BOX 1883
FPO AP
96350
US

V. Phone/Fax

Practice location:
  • Phone: 46-816-7260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5584
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: