MEDICARE: KIMBERLY GRAYBEAL

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
1	225100000X	Physical Therapist	1124915	TX

General Provider Information

NPI Number	:	1174922835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY GRAYBEAL

Provider Business Mailing Address
First Line	:	5300 ALTAMESA BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76133-5924
Country	:	US
Telephone Number	:	817-346-1800
Fax Number	:	817-423-5842

Provider Business Practice Location Address
First Line	:	5300 ALTAMESA BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76133-5924
Country	:	US
Telephone Number	:	817-346-1800
Fax Number	:	817-423-5842

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	08/19/2014

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Directions to “ KIMBERLY GRAYBEAL ” Practice Location

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