Active NPI
Kimberly R Davis, PT
- Physical Therapist
- Louisville, KY
National Provider Identifier
1760029698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 4331 Churchman Ave Ste 102
Louisville, KY 40215-1196 - Phone
- (502) 366-1773
- NPI assigned
- Dec 10, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
4331 Churchman Ave Ste 102
Louisville, KY 40215-1196
Mailing address
614 Westport Rd Ste a
Elizabethtown, KY 42701-3832
Phone (502) 366-1773
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14588078 | Other | KY | CAQH |
| 7100642630 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616716800000",
"number": "1760029698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "614 WESTPORT RD STE A",
"city": "ELIZABETHTOWN",
"state": "KY",
"postal_code": "427013832",
"telephone_number": "502-366-1773",
"fax_number": "270-234-8197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4331 CHURCHMAN AVE STE 102",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402151196",
"telephone_number": "502-366-1773"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "KIMBERLY",
"middle_name": "R",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-10",
"last_updated": "2021-03-26",
"certification_date": "2021-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "14588078",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100642630",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.