Molly Kaleen Kimball, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA30282 Issued in FL

Practice address

721 W Robertson St Ste 102
Brandon, FL 33511-4900

Phone

(862) 676-8502

NPI assigned

Nov 2, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677456000000",
    "number": "1255932729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4630 MCINTOSH RD. SITE J-37",
            "city": "DOVER",
            "state": "FL",
            "postal_code": "33527",
            "telephone_number": "940-867-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 W ROBERTSON ST STE 102",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114900",
            "telephone_number": "862-676-8502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "MOLLY",
        "middle_name": "KALEEN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-02",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "FL",
            "license": "PTA30282",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA30282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kids Therapy Unlimited, Inc.
• Kids' Corner Pediatrics
• Jessica Kiehl, OTR/L
• John M. Kilgore, M.C.
• Calvin K Kim, M.D.
• Kimberly W. Miller, Psy.D., P.a.
• Anthony Cameron King, D.P.T.
• Courtney Lee-Paige King, PA-C
• Denise King
• Donna Lee King, ARNP

• Physical Therapy Assistant in Brandon, FL
• Providers in Brandon, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.