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General NPI Number Information
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NPI Number | 1033452289
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Entity Type | Individual
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Provider Name | KIMBERLY MANTHA HAMLIN LMT
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Gender | Female
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 12/11/2018
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Provider Practice Location Address
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Address Line | 267 W DUVAL RD STE 105
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-4344
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Country | US
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Telephone | 520-204-5351
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Fax |
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Provider Business Mailing Address
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Address Line | 390 W CALLE FRANJA VERDE
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City | SAHUARITA
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State | AZ
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Zip | 85629-8199
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Country | US
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Telephone | 520-442-7500
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Fax |
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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 | MT23715
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License Number State | AZ
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