Provider Demographics
NPI:1447639513
Name:RAFIEL, KIMSIE NICOLE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KIMSIE
Middle Name:NICOLE
Last Name:RAFIEL
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 BONNY OAKS DR
Mailing Address - Street 2:APT. 209
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-3908
Mailing Address - Country:US
Mailing Address - Phone:423-310-3649
Mailing Address - Fax:423-499-9318
Practice Address - Street 1:7430 COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2669
Practice Address - Country:US
Practice Address - Phone:423-499-9418
Practice Address - Fax:423-499-9318
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer