Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT292762 | CA |
N | 225200000X | Physical Therapy Assistant |
NPI | 1063962025 |
---|---|
Provider Name | Kimberly Keathley |
First Address | Bakersfield, CA 93309-0745 |
Second Address | Bakersfield, CA 93309-0745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2016 |
Last Update Date | 12/04/2017 |