Healthcare Provider Details

I. General information

NPI: 1831689207
Provider Name (Legal Business Name): KIMBERLY M KLIKUS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 10/02/2024
Certification Date: 04/04/2022
Deactivation Date: 04/04/2022
Reactivation Date: 10/02/2024

III. Provider practice location address

1527 LINCOLN HWY STE 1100
SOMERSET NJ
08873-3979
US

IV. Provider business mailing address

1527 LINCOLN HWY STE 1100
SOMERSET NJ
08873-3979
US

V. Phone/Fax

Practice location:
  • Phone: 732-545-7474
  • Fax: 732-545-2880
Mailing address:
  • Phone: 732-545-7474
  • Fax: 732-545-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number40QB00348900
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: