Provider Demographics
NPI:1992444806
Name:BAILEY, KIMBERLY (ATC, PTA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC, PTA
Mailing Address - Street 1:1451 DR EDWARD HILLARD DR STE 130
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7449
Mailing Address - Country:US
Mailing Address - Phone:205-561-5899
Mailing Address - Fax:205-860-7029
Practice Address - Street 1:1451 DR EDWARD HILLARD DR STE 130
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7449
Practice Address - Country:US
Practice Address - Phone:205-461-5899
Practice Address - Fax:205-860-7029
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7002081S0010X, 2255A2300X
ALPTA9407225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant