Healthcare Provider Details

I. General information

NPI: 1154253938
Provider Name (Legal Business Name): KIMBERLY LYNN MOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 NE CEDAR ST
JENSEN BEACH FL
34957-4808
US

IV. Provider business mailing address

9420 FOUNTAIN MEDICAL CT STE 101
BONITA SPRINGS FL
34135-4571
US

V. Phone/Fax

Practice location:
  • Phone: 239-488-1583
  • Fax: 239-309-0219
Mailing address:
  • Phone: 239-488-1583
  • Fax: 239-309-0219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT12689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: