MEDICARE: KIMBERLY LINDEMANN 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	1342	ND

General Provider Information

NPI Number	:	1457395022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY LINDEMANN PT

Provider Business Mailing Address
First Line	:	232 SUNTREE CT
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-4507
Country	:	US
Telephone Number	:	701-492-7464
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 SUNTREE CT
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-4507
Country	:	US
Telephone Number	:	701-492-7464
Fax Number	:

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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