Healthcare Provider Details

I. General information

NPI: 1225463094
Provider Name (Legal Business Name): KIMBERLY W MATTHES CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 SPRING ST STE C
PASO ROBLES CA
93446-1454
US

IV. Provider business mailing address

PO BOX 2666
PASO ROBLES CA
93447-2666
US

V. Phone/Fax

Practice location:
  • Phone: 805-712-2875
  • Fax:
Mailing address:
  • Phone: 805-712-2875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number17751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: