Kimberly Bodnar Castle, PT, PHD, PCS

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT011273 Issued in GA

Practice address

1100 Old Dawson Village Rd E Ste 10
Dawsonville, GA 30534-3807

Phone

(608) 526-9888

Fax

(608) 526-9865

NPI assigned

Jun 3, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Dr. Kimberly Bodnar Harbst Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1243987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531958400000",
    "number": "1508092644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 OLD DAWSON VILLAGE RD E STE 10",
            "city": "DAWSONVILLE",
            "state": "GA",
            "postal_code": "305343807",
            "telephone_number": "678-367-2382",
            "fax_number": "678-805-8452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 OLD DAWSON VILLAGE RD E STE 10",
            "city": "DAWSONVILLE",
            "state": "GA",
            "postal_code": "305343807",
            "telephone_number": "608-526-9888",
            "fax_number": "608-526-9865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASTLE",
        "first_name": "KIMBERLY",
        "middle_name": "BODNAR",
        "credential": "PT, PHD, PCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-03",
        "last_updated": "2018-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "GA",
            "license": "PT011273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40146300",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508092644",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "HARBST",
            "middle_name": "BODNAR",
            "prefix": "DR.",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Caitlyn Carr
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• Jeffrey Scott Charpentier, M.D.
• Susan Jackson Cheek
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• All providers in Dawsonville, GA
• Pediatric Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; 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.