Active NPI
Kimberly Marie Mauk, PTA
- Physical Therapy Assistant
- Pace, FL
National Provider Identifier
1669582375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 32737
- Practice address
- 3876 Highway 90
Andrews Institute Rehabilitation
Pace, FL 32571 - Phone
- (448) 227-7075
- NPI assigned
- Aug 30, 2006
- Last updated
- Dec 6, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | NU | ||
| Physical Therapy Assistant | 225200000X | 32737 | FL | Primary |
Addresses
Primary practice location
3876 Highway 90
Andrews Institute Rehabilitation
Pace, FL 32571
Mailing address
5427 Peach Dr
Milton, FL 32571-2773
Phone (301) 908-1356
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A1619 | Other | MD | LICENSE# |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32737 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733443200000",
"number": "1669582375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5427 PEACH DR",
"city": "MILTON",
"state": "FL",
"postal_code": "325712773",
"telephone_number": "301-908-1356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3876 HIGHWAY 90",
"address_2": "ANDREWS INSTITUTE REHABILITATION",
"city": "PACE",
"state": "FL",
"postal_code": "32571",
"telephone_number": "448-227-7075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAUK",
"first_name": "KIMBERLY",
"middle_name": "MARIE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2024-12-06",
"certification_date": "2024-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "32737",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE#",
"identifier": "A1619",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pace, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.