Individual
JORDAN KIMBALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
130 CRISANTO AVE STE A, FORT MILL, SC 29715-6272
(803) 746-4655
Mailing address
PO BOX 412066, BOSTON, MA 02241-2313
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
114750
IA
225100000X
Physical Therapist
Primary
12276
SC
225100000X
Physical Therapist
P22943
NC
Other
Enumeration date
05/27/2022
Last updated
03/19/2024
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