Individual
KIMBRALY A KETTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
4603 TIMBERWALK CT, LA GRANGE, KY 40031-6746
(703) 864-6695
(888) 830-3233
Mailing address
4603 TIMBERWALK CT, LA GRANGE, KY 40031-6746
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
007521
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002097665
MT STATE BCBS
WV
01
—
1073906
BRICKSTREET - WORKERS COMP
WV
01
—
PT002705
LICENSE #
WV
Enumeration date
03/23/2007
Last updated
02/27/2020
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