Provider Demographics
NPI:1972553428
Name:MCGLOTHLIN, KIMBERLY K (PT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:K
Last Name:MCGLOTHLIN
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 1:508 BURKLEY CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1613
Mailing Address - Country:US
Mailing Address - Phone:423-956-0508
Mailing Address - Fax:
Practice Address - Street 1:508 BURKLEY CT
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1613
Practice Address - Country:US
Practice Address - Phone:423-956-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4092663OtherBLUE CROSS
TN3659517Medicaid
TN4092663OtherBLUE CROSS