Provider Demographics
NPI:1063673192
Name:CASTILLO, KIMBERLY A (LMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:LEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:816 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6419
Mailing Address - Country:US
Mailing Address - Phone:360-457-0608
Mailing Address - Fax:360-417-3413
Practice Address - Street 1:816 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6419
Practice Address - Country:US
Practice Address - Phone:360-457-0608
Practice Address - Fax:360-417-3413
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020520225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist