Kimberly Carroll Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

KIMBERLY CARROLL PHYSICAL THERAPY LLC

Practice address

120 N 2ND St
Fernandina Beach, FL 32034-4191

Phone

(904) 761-8397

NPI assigned

Sep 26, 2022

Last updated

Sep 26, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly Michelle Carroll, DPT, ATC, CERT. DNNPI 1407181191

Title

Owner/PT

Phone

(904) 583-2936

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kimberly M Carroll, PT

  • Physical Therapist
  • Fernandina Beach, FL
  • NPI 1407181191
  Authorized official Same address or phone

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

{
    "created_epoch": "1664150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664150400000",
    "number": "1548983497",
    "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",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320344191",
            "telephone_number": "904-761-8397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY CARROLL PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-26",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-12",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER/PT",
        "authorized_official_telephone_number": "904-583-2936",
        "authorized_official_credential": "DPT, ATC, CERT. DN"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Stuart Kelly, M.D.
• Joanna E. Kelly, CRNA
• Paula Mae Kelsor, R
• Melissa Kenner, LCSW
• Elizabeth Killmeyer
• Philip Kinard, M.ED, BCBA
• Amelia Claire Kirby, MS, CF-SLP
• Laurie A Kitson, DMD
• Michael C Knudstrup, PHARMACIST
• Diana Kornetti, PT

• Physical Therapy Clinic/Center in Fernandina Beach, FL
• Providers in Fernandina Beach, FL by specialty
• Physical Therapy Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.