Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1064640 | TX |
Y | 225100000X | Physical Therapist | PT25044 | FL |
N | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1043338288 |
---|---|
Provider Name | Kimberley D Carson |
First Address | St Petersburg, FL 33701-4634 |
Second Address | St Petersburg, FL 33701-4634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 21/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107975803 | (05) | TX |