Individual provider Active NPI

Kimberly Space, DPT

  • Physical Therapist
  • Goose Creek, SC
National Provider Identifier
1285946392
Registry record updated Oct 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6019 Issued in SC
Practice address
514 Saint James Ave Unit G
Goose Creek, SC 29445
Phone
(843) 642-8660
NPI assigned
Jul 6, 2010
Last updated
Oct 28, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6019 SC Primary

Addresses

Primary practice location

514 Saint James Ave Unit G
Goose Creek, SC 29445

Mailing address

800 Crescent Centre Dr Ste 300
Franklin, TN 37067-7285
Phone (615) 373-1350

Other practice location 1

7 Carnegie Plz
Cherry Hill, NJ 08003-1000
Phone (877) 407-3422

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100924000426 SC Practitioner - Physical Therapist in Private Practice 9638295892 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Medical University of South Carolina College of Medicine, 2009
Medicare assignment
May accept Medicare assignment
Group practices
Benchmark Healthcare Services LLCGroup PAC ID 3779726468, 136 clinicians

Practice addresses (Care Compare)

1000 Tanner Ford Blvd
Suite 370
Hanahan, SC 29410-4712
Phone (843) 718-1058

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6019SCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Drayer Physical Therapy - South Carolina, LLC Physical Therapist CurrentSince May 24, 2024 Accepting new patients
Benchmark Health Services Physical Therapist CurrentSince Apr 5, 2024 Accepting new patients
Agilitas USA, Inc Physical Therapist CurrentSince Nov 18, 2019 Accepting new patients
Benchmark Healthcare Services, LLC Physical Therapist CurrentSince Apr 5, 2024 Accepting new patients
Drayer Physical Therapy-South Carolina, LLC Physical Therapist CurrentSince May 24, 2024 Accepting new patients
Agilitas USA Inc Physical Therapist CurrentSince Nov 18, 2019 Accepting new patients
Rehabilitation Centers of Charleston, LLC Physical Therapist Past Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

130 Amicks Ferry Rd
#G
Chapin, SC 29036
Phone (803) 932-2176

514 Saint James Ave
Unit G
Goose Creek, SC 29445
Phone (843) 642-8660

1000 Tanner Ford Blvd
Ste 370
Hanahan, SC 29410
Phone (843) 718-1058

7585 Saint Andrews Rd
Irmo, SC 29063
Phone (803) 749-5031

3032 W Montague Ave
Ste 101
North Charleston, SC 29418
Phone (843) 885-8772

800 Crescent Centre Dr
Ste 300
Franklin, TN 37067

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1278374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572220800000",
    "number": "1285946392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CRESCENT CENTRE DR STE 300",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370677285",
            "telephone_number": "615-373-1350",
            "fax_number": "615-221-9054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 SAINT JAMES AVE UNIT G",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "29445",
            "telephone_number": "843-642-8660"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7 Carnegie Plz",
            "address_purpose": "LOCATION",
            "city": "Cherry Hill",
            "state": "NJ",
            "postal_code": "080031000",
            "country_code": "US",
            "telephone_number": "877-407-3422",
            "fax_number": "877-407-4329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPACE",
        "first_name": "KIMBERLY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-06",
        "last_updated": "2019-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "6019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goose Creek, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.