Provider Demographics
NPI:1821419854
Name:YOURICK, KIM CHAMPINE (MBA, PT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:CHAMPINE
Last Name:YOURICK
Suffix:
Gender:F
Credentials:MBA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 MAINSTAY PL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-2417
Mailing Address - Country:US
Mailing Address - Phone:678-366-0183
Mailing Address - Fax:
Practice Address - Street 1:4411 SUWANEE DAM RD
Practice Address - Street 2:SUITE 330
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8701
Practice Address - Country:US
Practice Address - Phone:770-904-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006404225100000X
TX1031870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist