MEDICARE: CAROLINE MAZYCK KIMBER PT

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	17356	NC

General Provider Information

NPI Number	:	1528587334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE MAZYCK KIMBER PT

Provider Business Mailing Address
First Line	:	305 OLD FOX TRAIL
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 ERWIN ROAD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27710-2599
Country	:	US
Telephone Number	:	919-681-2030
Fax Number	:

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

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	10/25/2024

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