Healthcare Provider Details

I. General information

NPI: 1720911829
Provider Name (Legal Business Name): KIMBERLY LAWSON LMBT, MLD, MMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5282 LYNGATE CT STE 5
BURKE VA
22015-1688
US

IV. Provider business mailing address

5282 LYNGATE CT STE 5
BURKE VA
22015-1688
US

V. Phone/Fax

Practice location:
  • Phone: 571-397-6515
  • Fax:
Mailing address:
  • Phone: 571-397-6515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT200001314
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number1401189892
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019019486
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: