Individual provider Active NPI

Kimberly Michele McKinstry, PT

  • Physical Therapist
  • Diamond Springs, CA
National Provider Identifier
1164623187
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT14008 Issued in CA
Practice address
4250 Fowler LN Ste 101
Diamond Springs, CA 95619-9782
Phone
(530) 306-1497
Fax
(530) 344-7589
NPI assigned
May 29, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT14008 CA Primary

Addresses

Primary practice location

4250 Fowler LN Ste 101
Diamond Springs, CA 95619-9782

Mailing address

4224 Fowler LN Ste 102
Diamond Springs, CA 95619-9775
Phone (530) 306-1497

Other practice location 1

2021 Smith Flat Rd
Placerville, CA 95667-5038
Phone (530) 306-1497

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
DPT Holdings, LLC Physical Therapist CurrentSince Sep 1, 2025 Accepting new patients

Locations

6070 Avenida Encinas
Ste 100
Carlsbad, CA 92011
Phone (760) 444-0102

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1164623187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4224 FOWLER LN STE 102",
            "city": "DIAMOND SPRINGS",
            "state": "CA",
            "postal_code": "956199775",
            "telephone_number": "530-306-1497",
            "fax_number": "530-344-7589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 FOWLER LN STE 101",
            "city": "DIAMOND SPRINGS",
            "state": "CA",
            "postal_code": "956199782",
            "telephone_number": "530-306-1497",
            "fax_number": "530-344-7589"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2021 Smith Flat Rd",
            "address_purpose": "LOCATION",
            "city": "Placerville",
            "state": "CA",
            "postal_code": "956675038",
            "country_code": "US",
            "telephone_number": "530-306-1497",
            "fax_number": "530-295-0607",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKINSTRY",
        "first_name": "KIMBERLY",
        "middle_name": "MICHELE",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-29",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT14008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Diamond Springs, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.