Provider Demographics
NPI:1225463094
Name:MATTHES, KIMBERLY W (CMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:W
Last Name:MATTHES
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2666
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93447-2666
Mailing Address - Country:US
Mailing Address - Phone:805-712-2875
Mailing Address - Fax:
Practice Address - Street 1:2138 SPRING ST STE C
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-1454
Practice Address - Country:US
Practice Address - Phone:805-712-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17751172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist