Provider Demographics
NPI:1033452289
Name:HAMLIN, KIMBERLY MANTHA (LMT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MANTHA
Last Name:HAMLIN
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 1:390 W CALLE FRANJA VERDE
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8199
Mailing Address - Country:US
Mailing Address - Phone:520-442-7500
Mailing Address - Fax:
Practice Address - Street 1:267 W DUVAL RD STE 105
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4344
Practice Address - Country:US
Practice Address - Phone:520-204-5351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT23715225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty