Provider Demographics
NPI:1619496429
Name:HARDIN, KIMBER LE (LMT)
Entity Type:Individual
Prefix:
First Name:KIMBER
Middle Name:LE
Last Name:HARDIN
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 1:1275 NE GRANT ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3482
Mailing Address - Country:US
Mailing Address - Phone:971-227-2568
Mailing Address - Fax:
Practice Address - Street 1:2004 MAIN ST STE 311
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-7338
Practice Address - Country:US
Practice Address - Phone:971-227-2568
Practice Address - Fax:971-227-2568
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12302225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist