MEDICARE: KIMBERLY MICHELE MCKINSTRY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT14008	CA

General Provider Information

NPI Number	:	1164623187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MICHELE MCKINSTRY PT

Provider Business Mailing Address
First Line	:	4224 FOWLER LN STE 102
Second Line	:
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-9775
Country	:	US
Telephone Number	:	530-306-1497
Fax Number	:	530-344-7589

Provider Business Practice Location Address
First Line	:	4250 FOWLER LN STE 101
Second Line	:
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-9782
Country	:	US
Telephone Number	:	530-306-1497
Fax Number	:	530-344-7589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/21/2022

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