Individual
MRS. KIMBERLY O MARSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3054 ENTERPRISE DR, STATE COLLEGE, PA 16801-2755
(814) 234-6023
(814) 234-1439
Mailing address
3054 ENTERPRISE DR, STATE COLLEGE, PA 16801-2755
(814) 234-6023
(814) 234-1439
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PTH2981
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04080
CRS PROVIDER #
AL
01
—
510-77696
BLUE CROSS PROVIDER NUMBE
AL
01
—
5984520
AETNA PROVIDER #
AL
05
—
890004630
—
AL
01
—
ONO4081
UHC PROVIDER #
AL
01
—
U409201
MAMSI PROVIDER #
AL
Enumeration date
01/12/2006
Last updated
09/28/2011
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