Provider Demographics
NPI:1255868907
Name:REXROAD, KIMBERLY (LMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:REXROAD
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:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-0586
Mailing Address - Country:US
Mailing Address - Phone:304-256-1111
Mailing Address - Fax:304-256-1113
Practice Address - Street 1:167 DRY HILL RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2603
Practice Address - Country:US
Practice Address - Phone:304-256-1111
Practice Address - Fax:304-256-1113
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2014-3267225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist