Provider Demographics
NPI:1962474775
Name:KIMBRO, SHERRY LOU (ATC)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:LOU
Last Name:KIMBRO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 SANDBROOK LN
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-3974
Mailing Address - Country:US
Mailing Address - Phone:205-391-9236
Mailing Address - Fax:205-348-4419
Practice Address - Street 1:1201 COLISEUM DRIVE
Practice Address - Street 2:COLISEUM ATHLETIC TRAINING ROOM
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35487-0001
Practice Address - Country:US
Practice Address - Phone:205-348-4421
Practice Address - Fax:205-348-4419
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL053174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL053OtherSTATE LICENSE