Provider Demographics
NPI:1619242476
Name:HOPE, KIMBERLI DIANE (LMP)
Entity Type:Individual
Prefix:
First Name:KIMBERLI
Middle Name:DIANE
Last Name:HOPE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22307 51ST AVE W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4003
Mailing Address - Country:US
Mailing Address - Phone:206-427-0599
Mailing Address - Fax:
Practice Address - Street 1:626 128TH ST SW
Practice Address - Street 2:SUITE 103B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6368
Practice Address - Country:US
Practice Address - Phone:425-513-1881
Practice Address - Fax:425-775-2225
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020667172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist