Individual
KIMBERLY R DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4331 CHURCHMAN AVE STE 102, LOUISVILLE, KY 40215-1196
(502) 366-1773
Mailing address
614 WESTPORT RD STE A, ELIZABETHTOWN, KY 42701-3832
(502) 366-1773
(270) 234-8197
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14588078
CAQH
KY
05
—
7100642630
—
KY
Enumeration date
12/10/2019
Last updated
03/26/2021
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