Provider Demographics
NPI:1477863157
Name:MELVAN, KIMBERLY FAITH (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FAITH
Last Name:MELVAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:FAITH
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 102831
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2831
Mailing Address - Country:US
Mailing Address - Phone:404-778-6330
Mailing Address - Fax:404-778-6370
Practice Address - Street 1:59 EXECUTIVE PARK S
Practice Address - Street 2:SUITE 1100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2208
Practice Address - Country:US
Practice Address - Phone:404-778-6330
Practice Address - Fax:404-778-6370
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07968R2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic