Provider Demographics
NPI:1669712014
Name:NIMIS, KARL LIAM (CMT)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:LIAM
Last Name:NIMIS
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:LIAM
Other - Middle Name:
Other - Last Name:NIMIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:3733 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1326
Mailing Address - Country:US
Mailing Address - Phone:612-481-5777
Mailing Address - Fax:
Practice Address - Street 1:3733 4TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1326
Practice Address - Country:US
Practice Address - Phone:612-481-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist