Kimberly T Ethridge, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3000 Issued in SC

Practice address

1476 Long Grove Dr
Mt Pleasant, SC 29464-7571

Phone

(843) 216-3535

NPI assigned

Dec 7, 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

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Medical University of South Carolina College of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Olympic Physical Therapy LLCGroup PAC ID 6800856428, 10 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.

• Olympic Physical Therapy LLC

  • Physical Therapist
  • Mt Pleasant, SC
  • NPI 1710060868
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1260144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311638400000",
    "number": "1619205499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1476 LONG GROVE DR",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294647571",
            "telephone_number": "843-216-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1476 LONG GROVE DR",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294647571",
            "telephone_number": "843-216-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHRIDGE",
        "first_name": "KIMBERLY",
        "middle_name": "T",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-07",
        "last_updated": "2011-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "3000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Marie Ernst, LPC, NCC, MS
• Elizabeth Thompson Ervin, PMHNP-BC
• Daylisse Jeniree Estades Quiros
• William Estes
• Amy P Etheridge, RN
• David M Eulau, O.D.
• Elaine Eustis, MD
• Thomas Chadwick Eustis, M.D.
• Maggie Wolman Evans, MD
• Rachael Jo Evans, OTR L CHT

• All providers in Mt Pleasant, SC
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2011; 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.