Provider Demographics
NPI:1093537771
Name:EVERETT, KIMBERLY N (LMT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:N
Last Name:EVERETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 KENDALL SPRINGS CT APT 201
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2528
Mailing Address - Country:US
Mailing Address - Phone:305-951-5809
Mailing Address - Fax:
Practice Address - Street 1:722 W MLK BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3133
Practice Address - Country:US
Practice Address - Phone:305-951-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA103544225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist