Individual
KIMBERLY GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
164 MOUNT PELIA RD STE 102, MARTIN, TN 38237-3835
(901) 587-6460
Mailing address
295 KIMERY LEVEE RD, SHARON, TN 38255-3223
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
333
LICENSE #
TN
Enumeration date
08/30/2006
Last updated
07/08/2007
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