Basic Information
| Provider Information | |||||||||
| NPI: | 1568649762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STILL | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | SELLERS | ||||||||
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| Credential: | LPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 578 UNION HILL RD SW | ||||||||
| Address2: | |||||||||
| City: | ARAB | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350161718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563384724 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2701 MERIDIAN ST N | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358111845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568525170 | ||||||||
| FaxNumber: | 2568588525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2008 | ||||||||
| LastUpdateDate: | 01/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA1121 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.