Provider Demographics
NPI:1316280183
Name:MCCANTS, KIMBERLY (LMT, CPT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MCCANTS
Suffix:
Gender:F
Credentials:LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 DREXEL LN
Mailing Address - Street 2:#4
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6118
Mailing Address - Country:US
Mailing Address - Phone:216-394-2401
Mailing Address - Fax:
Practice Address - Street 1:3280 DREXEL LN
Practice Address - Street 2:#4
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6118
Practice Address - Country:US
Practice Address - Phone:216-394-2401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-31
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT008043225700000X
OH33.018957225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist