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NPI Code Detail

MEDICARE: MR. JOHN MICHAEL KIMBRIEL LPTA

MEDICARE: MR. JOHN MICHAEL KIMBRIEL LPTA
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
1225200000XPhysical Therapy AssistantPTA2493MS

General Provider Information

NPI Number : 1033267554
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN MICHAEL KIMBRIEL LPTA
Provider Business Mailing Address
First Line : 138 ASHLEY DR
Second Line :
City : BRANDON
State : MS
Zip : 39042-2370
Country : US
Telephone Number : 601-829-7012
Fax Number :
Provider Business Practice Location Address
First Line : 711 AVIGNON DR
Second Line :
City : RIDGELAND
State : MS
Zip : 39157-5120
Country : US
Telephone Number : 601-605-6777
Fax Number : 601-605-8869
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 07/08/2007

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