Provider Demographics
NPI:1346252350
Name:CHAMBERS-GOOCH, KIMBERLY R (MS PT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:R
Last Name:CHAMBERS-GOOCH
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 US HIGHWAY 158
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-8463
Mailing Address - Country:US
Mailing Address - Phone:910-234-3155
Mailing Address - Fax:
Practice Address - Street 1:912 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2645
Practice Address - Country:US
Practice Address - Phone:919-603-3833
Practice Address - Fax:919-603-5833
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211427Medicaid
NC7211427Medicaid