Provider Demographics
NPI:1245685387
Name:BAXLEY, KIMBERLY (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BAXLEY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:FENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:922 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4581
Mailing Address - Country:US
Mailing Address - Phone:229-248-8499
Mailing Address - Fax:229-248-1595
Practice Address - Street 1:922 S WEST ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4581
Practice Address - Country:US
Practice Address - Phone:229-248-8499
Practice Address - Fax:229-248-1595
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist