Kim Champine Yourick, MBA, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT006404 Issued in GA

Practice address

4411 Suwanee Dam Rd
Suite 330
Suwanee, GA 30024-8701

Phone

(770) 904-2332

NPI assigned

Dec 17, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration

State licenses

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

{
    "created_epoch": "1387238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387238400000",
    "number": "1821419854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 MAINSTAY PL",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300222417",
            "telephone_number": "678-366-0183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 SUWANEE DAM RD",
            "address_2": "SUITE 330",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300248701",
            "telephone_number": "770-904-2332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOURICK",
        "first_name": "KIM",
        "middle_name": "CHAMPINE",
        "credential": "MBA, PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-17",
        "last_updated": "2013-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT006404",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1031870",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2013; 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.