Healthcare Provider Details

I. General information

NPI: 1750412631
Provider Name (Legal Business Name): KIM REIMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 EAST WOOD STREET CLEARWATER RETIREMENT COMMUNITY
CLEARWATER KS
67026
US

IV. Provider business mailing address

18819 W 29TH CT. NORTH
COLWICH KS
67030
US

V. Phone/Fax

Practice location:
  • Phone: 620-584-2271
  • Fax: 620-584-2277
Mailing address:
  • Phone: 316-259-3743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-01746
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: