Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 3389 | TN |
NPI | 1093129900 |
---|---|
Provider Name | Kimberly Sherman Lee |
First Address | Rock Island, TN 38581 |
Second Address | Rock Island, TN 38581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2014 |
Last Update Date | 18/06/2014 |