MEDICARE: KIMBERLY R. COAST P.T.

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	11-02673	KS

General Provider Information

NPI Number	:	1194818724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY R. COAST P.T.

Provider Business Mailing Address
First Line	:	P.O. BOX 191
Second Line	:	307 WEST CANAL
City	:	CIMARRON
State	:	KS
Zip	:	67835-0191
Country	:	US
Telephone Number	:	620-855-3693
Fax Number	:	620-855-3411

Provider Business Practice Location Address
First Line	:	1909 NORTH 14TH STREET
Second Line	:	SUITE C
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2364
Country	:	US
Telephone Number	:	620-338-8633
Fax Number	:	620-338-8121

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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