MEDICARE: KIMBERLY M SPIVEY P.T.

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	PT 1318	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	64-20055	OTHER	AR	UNITED HEALTHCARE
2	5U308	OTHER	AR	BLUE CROSS

General Provider Information

NPI Number	:	1497711014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY M SPIVEY P.T.

Provider Business Mailing Address
First Line	:	6601 FARM LN
Second Line	:
City	:	PINE BLUFF
State	:	AR
Zip	:	71603-1313
Country	:	US
Telephone Number	:	870-879-9245
Fax Number	:	870-541-0008

Provider Business Practice Location Address
First Line	:	2801 S OLIVE ST
Second Line	:	SUITE 9D
City	:	PINE BLUFF
State	:	AR
Zip	:	71603-5439
Country	:	US
Telephone Number	:	870-541-0003
Fax Number	:	870-541-0008

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

Provider Enumeration Date	:	04/22/2006
Last Update Date	:	07/08/2007

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Directions to “ KIMBERLY M SPIVEY P.T.” Practice Location

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