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General NPI Number Information
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NPI Number | 1063045698
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Entity Type | Individual
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Provider Name | KIMBERLY EVE KROEZE PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 3 MEDICAL PLZ
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-2918
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Country | US
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Telephone | 807-424-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 1109 6TH ST NE
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City | SIOUX CENTER
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State | IA
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Zip | 51250-1644
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Country | US
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Telephone | 712-578-9632
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP001312T
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 099304
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License Number State | IA
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