Kimberly Ann Mavronicles, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

06003357A Issued in IN

Practice address

118 Medical Dr
Carmel, IN 46032-3323

Phone

(317) 498-1098

NPI assigned

Jul 14, 2008

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1215993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701907200000",
    "number": "1679737258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3840 S COUNTY ROAD 475 E",
            "city": "HARDINSBURG",
            "state": "IN",
            "postal_code": "471256532",
            "telephone_number": "317-498-1098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 MEDICAL DR",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460323323",
            "telephone_number": "317-498-1098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVRONICLES",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-14",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IN",
            "license": "06003357A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamara Mattingly, RN
• Anthony Matulis, OT
• Chelsea Matura
• Raj K Maturi, MD
• Paula Eileen Mauzy, RPH
• Jordan Rebekah Maxwell, NP-C
• Deborah Lynn May, CNS DNS
• Jonathan B May, BCBA
• Julie A May, OD
• Shania Grace Mayer, PA-C

• Physical Therapy Assistant in Carmel, IN
• Providers in Carmel, IN by specialty
• Physical Therapy Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; 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.