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NPI Code Detail

MEDICARE: KIMBERLY ELAINE PERRA PTA

MEDICARE: KIMBERLY ELAINE PERRA PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11468OTHERGAPHYSICAL THERAPIST ASSISTANT
21468OTHERGAPHYSICAL THERAPIST ASSIST

General Provider Information

NPI Number : 1033646567
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY ELAINE PERRA PTA
Provider Business Mailing Address
First Line : 265 POCKET RD
Second Line :
City : CHICKAMAUGA
State : GA
Zip : 30707-4732
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 110 PARK CITY RD
Second Line :
City : ROSSVILLE
State : GA
Zip : 30741-3980
Country : US
Telephone Number : 706-858-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2017
Last Update Date : 05/15/2017

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Directions to “ KIMBERLY ELAINE PERRA PTA” Practice Location

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