Kimberly Stanford, PT, DPT, OCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

014919 Issued in GA

Practice address

248 E Crogan St Ste 5
Lawrenceville, GA 30046-5069

Phone

(770) 910-7227

Fax

(470) 221-1514

NPI assigned

Feb 24, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Trident Physical Therapy, LLCGroup PAC ID 6709279961, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Trident Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Lawrenceville, GA
  • NPI 1275204943
  Medicare reassignment Care Compare group NPD Authorized official
• Memorial Hermann Health System

  • Community/Retail Pharmacy
  • Houston, TX
  • NPI 1366229619
  NPD (past)

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

{
    "created_epoch": "1582502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657756800000",
    "number": "1568096014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 E CROGAN ST STE 5",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300465069",
            "telephone_number": "770-910-7227",
            "fax_number": "470-221-1514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "248 E CROGAN ST STE 5",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300465069",
            "telephone_number": "770-910-7227",
            "fax_number": "470-221-1514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANFORD",
        "first_name": "KIMBERLY",
        "credential": "PT, DPT, OCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-24",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "014919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devona M. Stalnaker-Shofner, LPC
• Anne Stambaugh, RN
• Jordan Mackenzie Stamper, NP
• Amanda Stamps, BCBA
• Cynthia Standard
• Sean Stanford Sr.
• Tiffany Stanford, LPC, NCC
• Star Shoes Corporation
• Star&Believe Health Care, LLC
• Carolyn H Starks, EDD, LPC

• Physical Therapist in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; 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.