Healthcare Provider Details

I. General information

NPI: 1962626374
Provider Name (Legal Business Name): KYMBAL RAI HURST PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

REFLECTX STAFFING 250 INTERNATIONAL PKWY
LAKE MARY FL
32746
US

IV. Provider business mailing address

7413 RONNIE AVE
WEST PADUCAH KY
42086-9536
US

V. Phone/Fax

Practice location:
  • Phone: 407-833-8815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA02017
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: