Provider Demographics
NPI:1699061622
Name:EDWARDS, KIMBERLY B (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:B
Last Name:EDWARDS
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 1:1221 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3602
Mailing Address - Country:US
Mailing Address - Phone:919-552-4580
Mailing Address - Fax:919-552-8438
Practice Address - Street 1:1221 BROAD ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-3602
Practice Address - Country:US
Practice Address - Phone:919-552-4580
Practice Address - Fax:919-552-8438
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist