Healthcare Provider Details

I. General information

NPI: 1861852741
Provider Name (Legal Business Name): KIMBERLY ZURA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N STEPHANIE ST STE 310
HENDERSON NV
89014-6608
US

IV. Provider business mailing address

400 N STEPHANIE ST STE 310
HENDERSON NV
89014-6608
US

V. Phone/Fax

Practice location:
  • Phone: 702-454-1162
  • Fax:
Mailing address:
  • Phone: 702-454-1162
  • Fax: 24-548-8177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number014776
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.003455
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5030
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: