Provider Demographics
NPI:1700027935
Name:RIENDEAU, KIMBERLY A (LMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:RIENDEAU
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 1:143 COLBURN RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-3508
Mailing Address - Country:US
Mailing Address - Phone:603-566-1829
Mailing Address - Fax:
Practice Address - Street 1:17 OLD NASHUA RD
Practice Address - Street 2:UNIT 1
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2844
Practice Address - Country:US
Practice Address - Phone:603-566-1829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1702M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist