Provider Demographics
NPI:1306962352
Name:ROBERTSON, KIMERON L (PT)
Entity type:Individual
Prefix:
First Name:KIMERON
Middle Name:L
Last Name:ROBERTSON
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 1:42445 HWY 195 E
Mailing Address - Street 2:VILLAGE EAST SHOPPING CENTER
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565
Mailing Address - Country:US
Mailing Address - Phone:205-486-8811
Mailing Address - Fax:205-486-8812
Practice Address - Street 1:42445 HWY 195 E
Practice Address - Street 2:VILLAGE EAST SHOPPING CENTER
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565
Practice Address - Country:US
Practice Address - Phone:205-486-8811
Practice Address - Fax:205-486-8812
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515 14392 ROBOtherBCBS OF ALABAMA PROV #