Provider Demographics
NPI:1477795250
Name:RICHARD, KIMBERLY JOLE (CMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOLE
Last Name:RICHARD
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 1:409 W CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-1627
Mailing Address - Country:US
Mailing Address - Phone:720-771-8128
Mailing Address - Fax:
Practice Address - Street 1:5140 W 120TH AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-3336
Practice Address - Country:US
Practice Address - Phone:303-451-6706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist