Provider Demographics
NPI:1013080480
Name:ALLEN, KIMBERLY MAE (LMP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MAE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S 152ND ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1107
Mailing Address - Country:US
Mailing Address - Phone:206-246-5370
Mailing Address - Fax:206-246-4806
Practice Address - Street 1:445 S 152ND ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1107
Practice Address - Country:US
Practice Address - Phone:206-246-5370
Practice Address - Fax:206-246-4806
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019643225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist