Healthcare Provider Details

I. General information

NPI: 1427179589
Provider Name (Legal Business Name): KIMBERLY DAWN KOTHE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10124 WEST BROAD ST., SUITE O
GLEN ALLEN VA
23060-3330
US

IV. Provider business mailing address

9111 ATLEE LAKE CT.
MECHANICSVILLE VA
23116-2871
US

V. Phone/Fax

Practice location:
  • Phone: 866-203-4365
  • Fax: 866-204-5425
Mailing address:
  • Phone: 804-789-9630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305004593
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: