Provider Demographics
NPI:1952777674
Name:KIMM, CALLIE ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:ELIZABETH
Last Name:KIMM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-5545
Mailing Address - Country:US
Mailing Address - Phone:803-441-0025
Mailing Address - Fax:803-441-0031
Practice Address - Street 1:500 FURYS FERRY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-7900
Practice Address - Country:US
Practice Address - Phone:706-210-9380
Practice Address - Fax:706-650-1896
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist