Provider Demographics
NPI:1497711014
Name:SPIVEY, KIMBERLY M (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6601 FARM LN
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-1313
Mailing Address - Country:US
Mailing Address - Phone:870-879-9245
Mailing Address - Fax:870-541-0008
Practice Address - Street 1:2801 S OLIVE ST
Practice Address - Street 2:SUITE 9D
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5439
Practice Address - Country:US
Practice Address - Phone:870-541-0003
Practice Address - Fax:870-541-0008
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 1318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR64-20055OtherUNITED HEALTHCARE
AR5U308OtherBLUE CROSS
AR5U308Medicare ID - Type Unspecified