MEDICARE: KIMBERLY LYNN BERSHADSKY 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	7842	GA

General Provider Information

NPI Number	:	1902872252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY LYNN BERSHADSKY P.T.

Provider Business Mailing Address
First Line	:	222 W CLINTON ST
Second Line	:	STE 3
City	:	GRAY
State	:	GA
Zip	:	31032-5457
Country	:	US
Telephone Number	:	478-986-5400
Fax Number	:	478-986-5443

Provider Business Practice Location Address
First Line	:	510 SETTLEMENT DRIVE
Second Line	:	SUITE 7
City	:	GRAY
State	:	GA
Zip	:	31032
Country	:	US
Telephone Number	:	478-986-5400
Fax Number	:	478-986-5443

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	10/10/2019

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Directions to “ KIMBERLY LYNN BERSHADSKY P.T.” Practice Location

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