Provider Demographics
NPI:1639394877
Name:TEMPLE, KIMBERLY ANNE ((LMT))
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:TEMPLE
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 1:2818 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-1244
Mailing Address - Country:US
Mailing Address - Phone:512-751-0508
Mailing Address - Fax:
Practice Address - Street 1:2818 SARATOGA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78733-1244
Practice Address - Country:US
Practice Address - Phone:512-751-0508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT015175174400000X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT015175Other1175M-MIDWIFE, LAY-
TXMT015175Other172M0000X-MECHANOTHERAP
TXMT015175Other175F0000X-NATUROPATH
TXMT015175Other171W000000X-CONTRACTOR-
TXMT01575Other1740000X-SPECIALIST
TX193200000XOtherCLINICAL LICENCED INSTRUCTOR PNF, NMR, MFR