Individual
KIMBERLY T BASCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
429 AVIATION RD, QUEENSBURY, NY 12804-2914
(518) 824-1600
Mailing address
14 FACTORY ST, GRANVILLE, NY 12832-1312
(518) 361-9753
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
005165
NY
Other
Enumeration date
09/08/2010
Last updated
09/08/2010
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