Provider Demographics
NPI:1962997809
Name:AUSTIN, KIMBERLY (CMT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9915 FAIR OAKS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7433
Mailing Address - Country:US
Mailing Address - Phone:916-257-8269
Mailing Address - Fax:
Practice Address - Street 1:9915 FAIR OAKS BLVD STE D
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7433
Practice Address - Country:US
Practice Address - Phone:916-257-8269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-23
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist