Provider Demographics
NPI:1154587400
Name:COMPONATION, KIMBERLY L (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:COMPONATION
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 WOODMILL WAY NW
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-7942
Mailing Address - Country:US
Mailing Address - Phone:256-880-4915
Mailing Address - Fax:
Practice Address - Street 1:927 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4306
Practice Address - Country:US
Practice Address - Phone:256-428-3000
Practice Address - Fax:256-428-3003
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1508947839OtherGROUP NPI
AL529-931220Medicaid
ALI392Medicare PIN