Healthcare Provider Details

I. General information

NPI: 1255859617
Provider Name (Legal Business Name): JAMES BRYSON KIMBROUGH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 HIGHWAY 145
SALTILLO MS
38866-9199
US

IV. Provider business mailing address

199 N BROOKMOORE DR
COLUMBUS MS
39705-2024
US

V. Phone/Fax

Practice location:
  • Phone: 662-869-9980
  • Fax: 662-869-9970
Mailing address:
  • Phone: 662-327-6705
  • Fax: 662-327-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6213
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: