Individual
JACKIE J KINGMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, ATC, PA-C, PT
Contact information
Practice address
1025 E 7TH ST, HPER C202, BLOOMINGTON, IN 47405-7109
(812) 855-1233
Mailing address
1025 E 7TH ST, HPER C202, BLOOMINGTON, IN 47405
(812) 855-1233
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
05009744A
IN
2255A2300X
Athletic Trainer
36001566A
IN
363A00000X
Physician Assistant
—
—
Other
Enumeration date
02/10/2006
Last updated
10/15/2012
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