Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 3950 | TN |
NPI | 1194186387 |
---|---|
Provider Name | Mrs. Kimberly Carter |
First Address | Memphis, TN 38163-2243 |
Second Address | Memphis, TN 38163-2243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2016 |
Last Update Date | 15/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0446645 | (05) | TN |
3133295 | BLUE CROSS BLUE SHIELD OF TN (01) | TN |
446645 | (02) | TN |