Provider Demographics
NPI:1326529264
Name:STARK, KIMBERLY MARIE (LMT, CMT)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:STARK
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2682 S CATHAY WAY UNIT 111
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-6047
Mailing Address - Country:US
Mailing Address - Phone:610-203-6198
Mailing Address - Fax:
Practice Address - Street 1:980 N GRANT ST STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2907
Practice Address - Country:US
Practice Address - Phone:303-832-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020153225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty