MEDICARE: MRS. KIMBERLY MARIE PETERS P.T.

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	9126	NC

General Provider Information

NPI Number	:	1285680462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY MARIE PETERS P.T.

Provider Business Mailing Address
First Line	:	4709 TURNSTONE DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-2227
Country	:	US
Telephone Number	:	919-376-1764
Fax Number	:

Provider Business Practice Location Address
First Line	:	3921 SUNSET RIDGE RD
Second Line	:	SUITE 101
City	:	RALEIGH
State	:	NC
Zip	:	27607-6677
Country	:	US
Telephone Number	:	919-420-0006
Fax Number	:	919-420-0072

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	07/08/2007

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