Provider Demographics
NPI:1164862116
Name:BAUGH, KIMMARCHELLO DENISE (DPT)
Entity type:Individual
Prefix:
First Name:KIMMARCHELLO
Middle Name:DENISE
Last Name:BAUGH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 GLACIER CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3534
Mailing Address - Country:US
Mailing Address - Phone:770-468-1115
Mailing Address - Fax:678-493-9464
Practice Address - Street 1:508 GLACIER CT
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-3534
Practice Address - Country:US
Practice Address - Phone:770-468-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-04
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0076722251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics