Provider Demographics
NPI:1902872252
Name:BERSHADSKY, KIMBERLY LYNN (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNN
Last Name:BERSHADSKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W CLINTON ST
Mailing Address - Street 2:STE 3
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-5457
Mailing Address - Country:US
Mailing Address - Phone:478-986-5400
Mailing Address - Fax:478-986-5443
Practice Address - Street 1:510 SETTLEMENT DRIVE
Practice Address - Street 2:SUITE 7
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032
Practice Address - Country:US
Practice Address - Phone:478-986-5400
Practice Address - Fax:478-986-5443
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
65BBCZXMedicare ID - Type Unspecified