MEDICARE: MRS. KIMBERLY BRUMMETT PT

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

General Provider Information

NPI Number	:	1255381596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY BRUMMETT PT

Provider Business Mailing Address
First Line	:	210 VILLAGE CENTER BLVD STE 140
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6706
Country	:	US
Telephone Number	:	843-353-3460
Fax Number	:	843-353-3461

Provider Business Practice Location Address
First Line	:	210 VILLAGE CENTER BLVD STE 200
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6706
Country	:	US
Telephone Number	:	843-353-3460
Fax Number	:	843-353-3461

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/20/2022

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