Provider Demographics
NPI:1679817415
Name:BROWN, KIMBERLY POPE (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:POPE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LEIGH
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:4704 CAHABA RIVER RD
Practice Address - Street 2:STE J2
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2344
Practice Address - Country:US
Practice Address - Phone:205-298-8711
Practice Address - Fax:205-298-8722
Is Sole Proprietor?:No
Enumeration Date:2012-11-17
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-47735OtherBCBS-CHELSEA
AL511-47734OtherBCBS-WEST MADISON
AL511-47732OtherBCBS-ATHENS
AL102I656979OtherMEDICARE PTAN
AL511-47731OtherBCBS-MOODY
AL511-47733OtherBCBS-HOOVER