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General NPI Number Information
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NPI Number | 1023206760
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Entity Type | Individual
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Provider Name | KIM G ANDERSON LMT
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Gender | Female
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 304 PONCE BLVD SUITE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32218-3863
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Country | US
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Telephone | 904-504-4563
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Fax | 904-751-3906
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Provider Business Mailing Address
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Address Line | 11333 VERA DR
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4159
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Country | US
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Telephone | 904-504-4563
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Fax | 904-751-3906
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA30630
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License Number State | FL
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