Provider Demographics
NPI:1831432772
Name:SWENSON, KIMBERLY (CMT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:SWENSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-1126
Mailing Address - Country:US
Mailing Address - Phone:970-756-6486
Mailing Address - Fax:
Practice Address - Street 1:450 CENTER ST
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-1126
Practice Address - Country:US
Practice Address - Phone:970-756-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0013071225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist