Provider Demographics
NPI:1083830194
Name:SPRUNGER, KIMBERLY LYNN (LMT)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:SPRUNGER
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 1:900 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3134
Mailing Address - Country:US
Mailing Address - Phone:503-740-2162
Mailing Address - Fax:503-538-5353
Practice Address - Street 1:606 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2912
Practice Address - Country:US
Practice Address - Phone:503-740-2162
Practice Address - Fax:503-538-5353
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11893225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist