Provider Demographics
NPI:1487972535
Name:JONES, KIMBERLY SUE (PTA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:JONES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 RUSH BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-5825
Mailing Address - Country:US
Mailing Address - Phone:859-948-5284
Mailing Address - Fax:
Practice Address - Street 1:4575 RUSH BRANCH RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-5825
Practice Address - Country:US
Practice Address - Phone:859-948-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01669225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant