Provider Demographics
NPI:1396174686
Name:ROSSI, KIMBERLY (LMP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ROSSI
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 1:1041 AL ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-8625
Mailing Address - Country:US
Mailing Address - Phone:360-221-2250
Mailing Address - Fax:
Practice Address - Street 1:11042 SR 525
Practice Address - Street 2:SUITE 207B
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-8618
Practice Address - Country:US
Practice Address - Phone:360-221-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA600491649225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist