Provider Demographics
NPI:1104031970
Name:BRIGHT, KIM (PT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 GARLINGTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5485
Mailing Address - Country:US
Mailing Address - Phone:864-288-2998
Mailing Address - Fax:864-288-3522
Practice Address - Street 1:1310 GARLINGTON RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5485
Practice Address - Country:US
Practice Address - Phone:864-288-2998
Practice Address - Fax:864-288-3522
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012241225100000X
SC7342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51539054OtherBLUE CROSS