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NPI Code Detail

MEDICARE: MRS. KIMBERLY NICOLE VANKLOMPENBURG PT, DPT

MEDICARE: MRS. KIMBERLY NICOLE VANKLOMPENBURG PT, DPT
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
12251P0200XPediatric Physical Therapist070.015609IL

General Provider Information

NPI Number : 1740302611
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY NICOLE VANKLOMPENBURG PT, DPT
Provider Business Mailing Address
First Line : 706 MEADOW DR
Second Line :
City : GLENVIEW
State : IL
Zip : 60025-3929
Country : US
Telephone Number : 847-894-3335
Fax Number :
Provider Business Practice Location Address
First Line : 6501 S PROMONTORY DR
Second Line :
City : CHICAGO
State : IL
Zip : 60649-1003
Country : US
Telephone Number : 773-256-5793
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 03/26/2015

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