Amy Lynn Kimball, PT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

02905 Issued in IA

Practice address

1717 Boyson Rd
Hiawatha, IA 52233-2313

Phone

(319) 200-2004

Fax

(319) 200-2009

NPI assigned

Jan 26, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Physical Therapy Partners

  • Physical Therapist
  • Waterloo, IA
  • NPI 1912987108
  NPD (past) Authorized official
• Proactive Pediatric Therapy, LLC

  • Rehabilitation Clinic/Center
  • Hiawatha, IA
  • NPI 1679121933
  NPD
• Rock Valley Physical Therapy Center

  • Physical Therapist
  • Moline, IL
  • NPI 1245373166
  NPD (past)

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1740250281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 BOYSON RD",
            "city": "HIAWATHA",
            "state": "IA",
            "postal_code": "522332313",
            "telephone_number": "319-200-2004",
            "fax_number": "319-200-2009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 BOYSON RD",
            "city": "HIAWATHA",
            "state": "IA",
            "postal_code": "522332313",
            "telephone_number": "319-200-2004",
            "fax_number": "319-200-2009"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "815 W Tower Park Dr",
            "address_purpose": "LOCATION",
            "city": "Waterloo",
            "state": "IA",
            "postal_code": "507019026",
            "country_code": "US",
            "telephone_number": "319-233-6995",
            "fax_number": "319-233-7083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "AMY",
        "middle_name": "LYNN",
        "credential": "PT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-26",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "IA",
            "license": "02905",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "02905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA PT LICENSE",
            "identifier": "02905",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.proactivepediatrictherapy.com/",
            "affiliation": "N",
            "endpointDescription": "ProActive website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "website",
            "address_1": "1717 Boyson Rd",
            "city": "Hiawatha",
            "state": "IA",
            "country_code": "US",
            "postal_code": "522332313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica Marie Kelley, M.D.
• Jamie Kenney
• Echo Anne Kent, LMFT
• Kevin G. Witt, DDS PLC
• Matthew James Kidwell, M.D.
• Jordan King, D.O., M.S.
• Emily Elizabeth Kittoe, OT
• Calla Jayne Henning Kleene, D.C.
• William Klima, LMHC
• Mark D Kline, MD

• Physical Therapist in Hiawatha, IA
• Providers in Hiawatha, IA by specialty
• Physical Therapist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; 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.