Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 0593 | SD |
NPI | 1134286206 |
---|---|
Provider Name | Ms. Kimberly Jean Brink |
First Address | Beresford, SD 57004-0307 |
Second Address | Beresford, SD 57004-2150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2007 |
Last Update Date | 28/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5833610 | (05) | SD |