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Individual
KIMBERLY SCOTT BASS
Active
Individual
KIMBERLY SCOTT BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2646
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079RY
BLUE CROSS BLUE SHIELD
NC
05
—
7211728
—
NC
01
—
E2479
MEDCOST
NC
01
—
P00319081
MEDICARE RAILROAD
NC
Enumeration date
11/10/2005
Last updated
06/02/2016
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