Provider Demographics
NPI:1275123655
Name:KIME, KASSIE (DPT)
Entity Type:Individual
Prefix:
First Name:KASSIE
Middle Name:
Last Name:KIME
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8308
Mailing Address - Country:US
Mailing Address - Phone:304-677-5477
Mailing Address - Fax:
Practice Address - Street 1:412 FAIRMONT AVE STE 2
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2792
Practice Address - Country:US
Practice Address - Phone:304-534-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV003314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist