Provider Demographics
NPI:1881703429
Name:SCHRAMM, KIMBERLY R (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:SCHRAMM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-758-4891
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:1240 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:SUMRALL
Practice Address - State:MS
Practice Address - Zip Code:39482
Practice Address - Country:US
Practice Address - Phone:601-758-4891
Practice Address - Fax:601-758-4903
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS640507572YKOtherAMERICAN ADMIN GROUP
MS03078701Medicaid
LA1419796Medicaid
MS640507572YKOtherAMERICAN ADMIN GROUP
Q36394Medicare UPIN
LA1419796Medicaid