MEDICARE: MISS KIMBERLY ANNE KUIKEN 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	40QA00858100	NJ

General Provider Information

NPI Number	:	1649310087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KIMBERLY ANNE KUIKEN P.T.

Provider Business Mailing Address
First Line	:	740 WALL ROAD
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762
Country	:	US
Telephone Number	:	732-682-3166
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 ROUTE 34 STE 317
Second Line	:
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-2517
Country	:	US
Telephone Number	:	732-252-6155
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	04/12/2021

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