Individual
MS. NICOLE ATHENA KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS PT
Contact information
Practice address
1313 W PARK STREET, SUITE # 7, LIVINGSTON, MT 59047
(406) 222-5519
(406) 222-0366
Mailing address
618 N 3RD, BOZEMAN, MT 59715
(406) 570-0535
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
0193081
NY
225100000X
Physical Therapist
Primary
1877
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3400826
—
MT
01
—
60503
BLUE CROSS BLUE SHIELD
MT
01
—
MSF1250520
MT STATE FUND
MT
01
—
P00122746
RAILROAD MEDICARE
—
Enumeration date
12/08/2006
Last updated
07/08/2007
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