Provider Demographics
NPI:1770771503
Name:GREENLAW, KIMBERLY ANN (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:GREENLAW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:365 LILY RD
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04429-4825
Mailing Address - Country:US
Mailing Address - Phone:207-478-1119
Mailing Address - Fax:
Practice Address - Street 1:365 LILY RD
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:ME
Practice Address - Zip Code:04429-4825
Practice Address - Country:US
Practice Address - Phone:207-478-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist