Provider Demographics
NPI:1750854246
Name:BRAY, KIMBERLY SUE (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:BRAY
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 1:35 HALLIE LN
Mailing Address - Street 2:
Mailing Address - City:RIDDLETON
Mailing Address - State:TN
Mailing Address - Zip Code:37151-2201
Mailing Address - Country:US
Mailing Address - Phone:615-735-7491
Mailing Address - Fax:
Practice Address - Street 1:278 DRY VALLEY RD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-5461
Practice Address - Country:US
Practice Address - Phone:931-537-6524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist