Provider Demographics
NPI:1750940946
Name:HARGIS, KIM C (PT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:C
Last Name:HARGIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 BRADLEY ROAD 252
Mailing Address - Street 2:
Mailing Address - City:WILMAR
Mailing Address - State:AR
Mailing Address - Zip Code:71675-9055
Mailing Address - Country:US
Mailing Address - Phone:870-723-3022
Mailing Address - Fax:
Practice Address - Street 1:404 LLAMA DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4785
Practice Address - Country:US
Practice Address - Phone:501-268-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist