Individual
KIMBERLY S. COCKRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0663
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120143300
—
WY
01
—
4995254
WELLMARK BC/BS
SD
05
—
5832932
—
SD
Enumeration date
07/11/2005
Last updated
01/30/2012
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