Provider Demographics
NPI:1912215245
Name:PEARCE, KIM (LMT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:PEARCE
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 1:11 HEPBURN PL
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3185
Mailing Address - Country:US
Mailing Address - Phone:321-474-1654
Mailing Address - Fax:
Practice Address - Street 1:11 HEPBURN PL
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3185
Practice Address - Country:US
Practice Address - Phone:321-474-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46090172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist