Provider Demographics
NPI:1134256654
Name:ROBERTS, KIMBERLY GAYLE (AP, LMT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GAYLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:AP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 ALOMA AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2522
Mailing Address - Country:US
Mailing Address - Phone:407-672-0072
Mailing Address - Fax:
Practice Address - Street 1:2431 ALOMA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2522
Practice Address - Country:US
Practice Address - Phone:407-672-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP721171100000X
FLMA10873174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174400000XOther Service ProvidersSpecialist