Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 792 | SC |
NPI | 1013105097 |
---|---|
Provider Name | Ann Kimball |
First Address | Hickory, NC 28602-1301 |
Second Address | Rock Hill, SC 29732-2342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2007 |
Last Update Date | 04/10/2007 |