Provider Demographics
NPI:1356438030
Name:LEDBETTER, KIMBERLY DAWN (PTA)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 HOMEPLACE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TUNNEL HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30755
Mailing Address - Country:US
Mailing Address - Phone:706-935-4225
Mailing Address - Fax:
Practice Address - Street 1:2125 NORTHPOINT BLVD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4072
Practice Address - Country:US
Practice Address - Phone:423-875-3376
Practice Address - Fax:423-875-3451
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3112225200000X
GA1653225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant