Provider Demographics
NPI:1376150094
Name:CULLER, KIMBERLY ELIZABETH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ELIZABETH
Last Name:CULLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:ELIZABETH
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:836 WINESTONE CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-9005
Mailing Address - Country:US
Mailing Address - Phone:252-339-1949
Mailing Address - Fax:
Practice Address - Street 1:836 WINESTONE CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-9005
Practice Address - Country:US
Practice Address - Phone:252-339-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7274225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant