Basic Information
| Provider Information | |||||||||
| NPI: | 1437750395 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DICKSON | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | PT,ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6129 AIRPORT HOTELS BLVD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402133288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029643688 | ||||||||
| FaxNumber: | 5029645874 | ||||||||
| Practice Location | |||||||||
| Address1: | 6129 AIRPORT HOTELS BLVD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402133288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029643688 | ||||||||
| FaxNumber: | 5029645874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2020 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 003842 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.