Provider Demographics
NPI:1629299011
Name:LARSON, KIMBERLY D (LMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:LARSON
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 1:100 N PINES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5117
Mailing Address - Country:US
Mailing Address - Phone:509-926-2511
Mailing Address - Fax:509-926-3002
Practice Address - Street 1:100 N PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5117
Practice Address - Country:US
Practice Address - Phone:509-926-2511
Practice Address - Fax:509-926-3002
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019679225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist