MEDICARE: GARY C. KIMBALL PT, OCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6984	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033102199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY C. KIMBALL PT, OCS

Provider Business Mailing Address
First Line	:	5 POWELL ST
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-5245
Country	:	US
Telephone Number	:	508-747-2823
Fax Number	:

Provider Business Practice Location Address
First Line	:	541 MAIN ST
Second Line	:	SUITE 103
City	:	SOUTH WEYMOUTH
State	:	MA
Zip	:	02190-1868
Country	:	US
Telephone Number	:	781-331-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/08/2007

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