Provider Demographics
NPI:1851653166
Name:CAIN, KIMBERLEY WALLACE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:WALLACE
Last Name:CAIN
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 1:6 KEYSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-5265
Mailing Address - Country:US
Mailing Address - Phone:864-223-2500
Mailing Address - Fax:
Practice Address - Street 1:6 KEYSTONE CIR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5265
Practice Address - Country:US
Practice Address - Phone:864-223-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics