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General NPI Number Information
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NPI Number | 1548983497
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Entity Type | Organization
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Legal Business Name | KIMBERLY CARROLL PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 120 N 2ND ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4191
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Country | US
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Telephone | 904-761-8397
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Fax |
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Provider Business Mailing Address
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Address Line | 2657 AMELIA RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-9112
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Country | US
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Telephone | 904-583-2936
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Fax |
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Authorized Official
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Title or Position | OWNER/PT
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Name | KIMBERLY MICHELLE CARROLL
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Credential | DPT, ATC, CERT. DN
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Telephone | 904-583-2936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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