Provider Demographics
NPI:1669483103
Name:CONNOR, KIMBERLY JOHNSON (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOHNSON
Last Name:CONNOR
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 1:2270 US HWY 74A
Mailing Address - Street 2:SUITE 341
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043
Mailing Address - Country:US
Mailing Address - Phone:828-247-1588
Mailing Address - Fax:828-247-1692
Practice Address - Street 1:2270 US HWY 74A
Practice Address - Street 2:SUITE 341
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043
Practice Address - Country:US
Practice Address - Phone:828-247-1588
Practice Address - Fax:828-247-1692
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
079K0OtherBCBS