Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 14695 | CA |
N | 2251S0007X | Physical Therapist - Sports | 14695 | CA |
NPI | 1063175032 |
---|---|
Provider Name | Kimberly Jean Burton |
First Address | Palm Springs, CA 92262-3318 |
Second Address | Palm Desert, CA 92211-8249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2021 |
Last Update Date | 18/10/2021 |