Provider Demographics
NPI:1114163409
Name:ALLEN, KIMBERLY ANNETTE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNETTE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4768 COUNTY ROAD 502B
Mailing Address - Street 2:
Mailing Address - City:SWEENY
Mailing Address - State:TX
Mailing Address - Zip Code:77480-8119
Mailing Address - Country:US
Mailing Address - Phone:979-236-3021
Mailing Address - Fax:979-548-4808
Practice Address - Street 1:4768 COUNTY ROAD 502B
Practice Address - Street 2:
Practice Address - City:SWEENY
Practice Address - State:TX
Practice Address - Zip Code:77480-8119
Practice Address - Country:US
Practice Address - Phone:979-236-3021
Practice Address - Fax:979-548-4808
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT033206171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor