Healthcare Provider Details

I. General information

NPI: 1659679892
Provider Name (Legal Business Name): KIMBERLY JEAN DEECK M.S.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2011
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 MAIN ST
SEWELL NJ
08080-4557
US

IV. Provider business mailing address

721 MAIN ST
SEWELL NJ
08080-4557
US

V. Phone/Fax

Practice location:
  • Phone: 856-494-8400
  • Fax: 856-494-8430
Mailing address:
  • Phone: 856-494-8400
  • Fax: 856-494-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT30205
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00880200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: