Healthcare Provider Details

I. General information

NPI: 1740250281
Provider Name (Legal Business Name): AMY LYNN KIMBALL PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 BOYSON RD
HIAWATHA IA
52233-2313
US

IV. Provider business mailing address

1717 BOYSON RD
HIAWATHA IA
52233-2313
US

V. Phone/Fax

Practice location:
  • Phone: 319-200-2004
  • Fax: 319-200-2009
Mailing address:
  • Phone: 319-200-2004
  • Fax: 319-200-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number02905
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number02905
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: