Healthcare Provider Details

I. General information

NPI: 1518682715
Provider Name (Legal Business Name): KIMBERLY PAIGE HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 LAWRENCEVILLE PLANK RD
LAWRENCEVILLE VA
23868-3351
US

IV. Provider business mailing address

588 FROZEN CRK
RACCOON KY
41557-8503
US

V. Phone/Fax

Practice location:
  • Phone: 434-848-4766
  • Fax:
Mailing address:
  • Phone: 606-454-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP015281A
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA04383
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: