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General NPI Number Information
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NPI Number | 1760395131
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Entity Type | Individual
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Provider Name | KIMBERLY MALMGREN PTA
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Gender | Female
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 3127 US HIGHWAY 98 N
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City | LAKELAND
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State | FL
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Zip | 33805-2103
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Country | US
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Telephone | 863-665-8881
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Fax |
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Provider Business Mailing Address
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Address Line | 15 20TH AVE
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City | ISLE OF PALMS
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State | SC
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Zip | 29451-2208
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Country | US
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Telephone |
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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 | 33870
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License Number State | FL
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