MEDICARE: MISS KIMBERLEE ELIZABETH HUTCHINS PHYSICAL THERAPIST

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	PT35490	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT35490	OTHER	CA	PT LICENSE

General Provider Information

NPI Number	:	1205063369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KIMBERLEE ELIZABETH HUTCHINS PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	341 MAGNOLIA AVE STE 101
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-3331
Country	:	US
Telephone Number	:	951-735-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	341 MAGNOLIA AVE STE 101
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-3331
Country	:	US
Telephone Number	:	951-735-6060
Fax Number	:	951-271-3959

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

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	01/25/2012

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