Provider Demographics
NPI:1114954831
Name:CROLEY, KIMBERLY BEARD (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BEARD
Last Name:CROLEY
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 1:5975 ROSWELL RD STE C333
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4086
Mailing Address - Country:US
Mailing Address - Phone:404-303-9153
Mailing Address - Fax:404-303-9154
Practice Address - Street 1:5975 ROSWELL RD NE STE C-333
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4048
Practice Address - Country:US
Practice Address - Phone:404-303-9153
Practice Address - Fax:404-816-4460
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBDQBMedicare PIN