Provider Demographics
NPI:1578055125
Name:GALLOWAY, KIMBERLY DENISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DENISE
Last Name:GALLOWAY
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 1:4854 6 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-0725
Mailing Address - Country:US
Mailing Address - Phone:865-856-0945
Mailing Address - Fax:
Practice Address - Street 1:2204 OLD NILES FERRY RD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-8863
Practice Address - Country:US
Practice Address - Phone:865-233-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT6946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist