Provider Demographics
NPI:1316791718
Name:KEYES, KIMBERLY A (LMT,RMT,LRT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:KEYES
Suffix:
Gender:F
Credentials:LMT,RMT,LRT
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:KEYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:THERAPEUTIC SVCS
Mailing Address - Street 1:804 FURMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3224
Mailing Address - Country:US
Mailing Address - Phone:361-446-9075
Mailing Address - Fax:
Practice Address - Street 1:5525 S STAPLES ST STE A5
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5361
Practice Address - Country:US
Practice Address - Phone:361-446-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX023700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty