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General NPI Number Information
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NPI Number | 1033813662
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Entity Type | Individual
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Provider Name | KIMBERLY WARREN PTA
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Gender | Female
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Dates
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Enumeration Date | 03/28/2023
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 6400 JEFFERSON ST NE STE 102
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3491
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Country | US
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Telephone | 505-344-2922
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Fax |
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Provider Business Mailing Address
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Address Line | 800 PUEBLO SOLANO RD NW
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City | LOS RANCHOS
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State | NM
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Zip | 87107-6418
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Country | US
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Telephone | 682-321-5524
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA1960
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License Number State | NM
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