| NPI | 1477684678 |
|---|---|
| Former Name | KIMBERLY JO QUACKENBUSH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2009006316) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 05-33658) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2025-10-03 |