Healthcare Provider Details

I. General information

NPI: 1649457060
Provider Name (Legal Business Name): KIMMY ANN MINKLER M.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E LOCKLING ST
BROOKFIELD MO
64628-2337
US

IV. Provider business mailing address

1502 MEADE ST
BROOKFIELD MO
64628-1030
US

V. Phone/Fax

Practice location:
  • Phone: 660-258-2222
  • Fax:
Mailing address:
  • Phone: 660-258-4771
  • Fax: 660-258-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2007026755
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: