Provider Demographics
NPI:1093129900
Name:LEE, KIMBERLY SHERMAN (PT, MSPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHERMAN
Last Name:LEE
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 SPENCER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38581
Mailing Address - Country:US
Mailing Address - Phone:615-473-8464
Mailing Address - Fax:
Practice Address - Street 1:1045 SPENCER RD
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:TN
Practice Address - Zip Code:38581
Practice Address - Country:US
Practice Address - Phone:615-473-8464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33892251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics