MEDICARE: MS. KIMBERLY ANNE TEMPLE (L.M.T.)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MT015175	TX
2	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	MT015175	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT015175	OTHER	TX	1175M-MIDWIFE, LAY-
2	MT015175	OTHER	TX	172M0000X-MECHANOTHERAP
3	MT015175	OTHER	TX	175F0000X-NATUROPATH
4	MT015175	OTHER	TX	171W000000X-CONTRACTOR-
5	MT01575	OTHER	TX	1740000X-SPECIALIST
6	193200000X	OTHER	TX	CLINICAL LICENCED INSTRUCTOR PNF, NMR, MFR

General Provider Information

NPI Number	:	1639394877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY ANNE TEMPLE (L.M.T.)

Provider Business Mailing Address
First Line	:	2818 SARATOGA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78733-1244
Country	:	US
Telephone Number	:	512-751-0508
Fax Number	:

Provider Business Practice Location Address
First Line	:	2818 SARATOGA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78733-1244
Country	:	US
Telephone Number	:	512-751-0508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	03/16/2011

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Directions to “ MS. KIMBERLY ANNE TEMPLE (L.M.T.)” Practice Location

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