Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2413 | NC |
NPI | 1003146192 |
---|---|
Provider Name | Kimberly B Mann |
First Address | Zebulon, NC 27597-2510 |
Second Address | Zebulon, NC 27597-2510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2010 |
Last Update Date | 12/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (02) | NC |
PENDING | (05) | NC |