Healthcare Provider Details

I. General information

NPI: 1710467436
Provider Name (Legal Business Name): KIMURA CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 COLUMBUS DR
ARCHBALD PA
18403-1542
US

IV. Provider business mailing address

304 COLUMBUS DR
ARCHBALD PA
18403-1542
US

V. Phone/Fax

Practice location:
  • Phone: 570-561-5384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberDAPT004046
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOSHUA PRALL
Title or Position: OWNER
Credential: DPT
Phone: 570-561-5384