Provider Demographics
NPI:1396002119
Name:KINSFATER, AIMEE ANNE (CMT)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:ANNE
Last Name:KINSFATER
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 1:1740 AMBERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-6395
Mailing Address - Country:US
Mailing Address - Phone:209-988-5507
Mailing Address - Fax:
Practice Address - Street 1:817 COFFEE RD STE D
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4241
Practice Address - Country:US
Practice Address - Phone:209-527-6100
Practice Address - Fax:209-527-6107
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27266225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist