Angelique Kimble, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA01210 Issued in RI

Practice address

309 Spring St # 2
Newport, RI 02840-6858

Phone

(401) 849-3204

NPI assigned

Jan 27, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1737936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1174335012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "969 W MAIN RD APT 2504",
            "city": "MIDDLETOWN",
            "state": "RI",
            "postal_code": "028426392",
            "telephone_number": "407-486-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 SPRING ST # 2",
            "city": "NEWPORT",
            "state": "RI",
            "postal_code": "028406858",
            "telephone_number": "401-849-3204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBLE",
        "first_name": "ANGELIQUE",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "RI",
            "license": "PTA01210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samir Khanjar, MD
• Kelli J. Kidd, M.S., R.D., LDN
• Mark E. Kilmer, PHD
• Elizabeth Kilzi, DPT
• Jee Hyun Kim, DO
• Sara Bates King, CNM, FNP
• Shannon Kinsella, LMHC
• Michael Dietrich Kirk, D.D.S.
• Bridget Kist
• Jason Ray Kizzee, ATC

• Physical Therapy Assistant in Newport, RI
• Providers in Newport, RI by specialty
• Physical Therapy Assistant in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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.