Provider Demographics
NPI:1245587179
Name:HENINGER, KIMBERLY S (LMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:HENINGER
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 1:5201 SW 91ST DR STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3019
Mailing Address - Country:US
Mailing Address - Phone:352-327-3561
Mailing Address - Fax:352-283-8231
Practice Address - Street 1:5201 SW 91ST DR STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3019
Practice Address - Country:US
Practice Address - Phone:352-327-3561
Practice Address - Fax:352-283-8231
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 18028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist