Healthcare Provider Details

I. General information

NPI: 1326159583
Provider Name (Legal Business Name): KIMBERLY THOMASON CRICE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 KENTUCKY AVE SUITE 103
PADUCAH KY
42003
US

IV. Provider business mailing address

405 ILLINOIS ST APT A
PADUCAH KY
42003
US

V. Phone/Fax

Practice location:
  • Phone: 270-575-0023
  • Fax: 270-575-9222
Mailing address:
  • Phone: 270-534-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA01041
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: