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General NPI Number Information
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NPI Number | 1417478934
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Entity Type | Individual
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Provider Name | KIMBERLY KERBO
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Gender | Female
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 1561 VIRGINIA AVE
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City | COLLEGE PARK
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State | GA
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Zip | 30337-2863
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Country | US
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Telephone | 470-331-9389
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Fax |
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Provider Business Mailing Address
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Address Line | 9756 CAROLINA DR
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City | JONESBORO
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State | GA
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Zip | 30238-8701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT009773
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License Number State | GA
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