Healthcare Provider Details

I. General information

NPI: 1235203498
Provider Name (Legal Business Name): KIMBERLY EILEEN KUZARA LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 200TH ST SW STE.D
LYNNWOOD WA
98036-6608
US

IV. Provider business mailing address

1753 NW 56TH ST #4
SEATTLE WA
98107-5223
US

V. Phone/Fax

Practice location:
  • Phone: 425-778-2325
  • Fax:
Mailing address:
  • Phone: 206-920-1341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00019005
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: