Loren Koda Kimble, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT35941 Issued in CA

Practice address

1600 Corporate Cir
Petaluma, CA 94954-6912

Phone

(707) 981-8604

Fax

(707) 981-8647

NPI assigned

Sep 23, 2009

Sex

Male

Sole proprietor

Yes

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

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Koda Physical Therapy and Sports PerformanceGroup PAC ID 6103102884, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Koda Physical Therapy and Sports Performance

  • Physical Therapy Clinic/Center
  • Petaluma, CA
  • NPI 1356797542
  Medicare reassignment Care Compare group Authorized official
• Backtogolf Performance & Fitness Inc

  • Physical Therapist
  • Santa Rosa, CA
  • NPI 1669571188
  NPD (past)
• Sutter Bay Medical Foundation

  • Multi-Specialty Clinic/Center
  • Sacramento, CA
  • NPI 1003267196
  NPD (past)

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

{
    "created_epoch": "1253664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489017600000",
    "number": "1336473362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 CORPORATE CIR",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546912",
            "telephone_number": "707-981-8604",
            "fax_number": "707-981-8647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 CORPORATE CIR",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546912",
            "telephone_number": "707-981-8604",
            "fax_number": "707-981-8647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBLE",
        "first_name": "LOREN",
        "middle_name": "KODA",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-09-23",
        "last_updated": "2017-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT35941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adil Khan
• Vanessa Khim
• Mohebbah Khushzad
• Isabelle Anne Kiefer
• Keith Parley Kilburn, MFT
• Kaitlin Kimmel, LPCC
• Lyndsey Ann Kinane, OT, CHT
• Alina Tsvet King, MA, LMFT
• Ginny King
• Maryjane Kinsey

• Physical Therapist in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.