Kimberly M Carroll, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT26306 Issued in FL

Practice address

120 N 2ND St Ste a
Fernandina Beach, FL 32034-4192

Phone

(904) 761-8397

Fax

(949) 404-6217

NPI assigned

Oct 13, 2009

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

Other names 1

• Kimberly M Hickox Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1255392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1407181191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2657 AMELIA RD",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320349112",
            "telephone_number": "904-583-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N 2ND ST STE A",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320344192",
            "telephone_number": "904-761-8397",
            "fax_number": "949-404-6217"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "961687 Gateway Blvd Ste 101A",
            "address_purpose": "LOCATION",
            "city": "Fernandina Beach",
            "state": "FL",
            "postal_code": "320349158",
            "country_code": "US",
            "telephone_number": "904-491-4980",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "KIMBERLY",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-13",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL2978",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT26306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "HICKOX",
            "middle_name": "M",
            "credential": "DPT, ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Fernandina Beach, FL
• Providers in Fernandina Beach, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; 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.