Provider Demographics
NPI:1780179721
Name:MEAGHER, KIMBERLY PAULEY (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PAULEY
Last Name:MEAGHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:PAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4406 S FLORIDA AVE STE 16
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2182
Mailing Address - Country:US
Mailing Address - Phone:636-881-8008
Mailing Address - Fax:863-688-1824
Practice Address - Street 1:4406 S FLORIDA AVE STE 16
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2182
Practice Address - Country:US
Practice Address - Phone:863-688-1800
Practice Address - Fax:636-881-8248
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist