=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609804988
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY ANN VIEIRA ATC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 0 GARETTSON ROAD
-----------------------------------------------------
City | BRIDGEWATER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-231-8660
-----------------------------------------------------
Fax | 908-231-1278
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73 KENNETH PL
-----------------------------------------------------
City | CLARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07066-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-231-8660
-----------------------------------------------------
Fax | 908-231-1278
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------