Provider Demographics
NPI:1134743438
Name:KNAUS, KIMBERLY A (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:KNAUS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 DUNN CIR
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-6398
Mailing Address - Country:US
Mailing Address - Phone:217-620-5520
Mailing Address - Fax:
Practice Address - Street 1:2934 S MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-9723
Practice Address - Country:US
Practice Address - Phone:217-864-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.001810225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist