Provider Demographics
NPI:1124386784
Name:ROBINSON, KIMBERLY ANN (LMP , MMP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LMP , MMP
Other - Prefix:
Other - First Name:TRANQUILITY
Other - Middle Name:
Other - Last Name:MASSAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP, MMP
Mailing Address - Street 1:4001 MAIN ST
Mailing Address - Street 2:SUITE 318
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-1887
Mailing Address - Country:US
Mailing Address - Phone:360-904-7296
Mailing Address - Fax:360-260-7496
Practice Address - Street 1:4001 MAIN ST
Practice Address - Street 2:SUITE 318
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-1887
Practice Address - Country:US
Practice Address - Phone:360-904-7296
Practice Address - Fax:360-260-7496
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60284884225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist