Provider Demographics
NPI:1689957359
Name:RUTHERFORD, KIMBERLY JOHNSON (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOHNSON
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:131 COMMONWEALTH DR
Mailing Address - Street 2:STE 200
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4883
Mailing Address - Country:US
Mailing Address - Phone:864-675-4651
Mailing Address - Fax:864-675-4625
Practice Address - Street 1:131 COMMONWEALTH DR
Practice Address - Street 2:STE 200
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4883
Practice Address - Country:US
Practice Address - Phone:864-675-4651
Practice Address - Fax:864-675-4625
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist