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General NPI Number Information
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NPI Number | 1134743438
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Entity Type | Individual
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Provider Name | KIMBERLY A KNAUS MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 06/02/2020
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 2934 S MOUNT ZION RD
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City | DECATUR
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State | IL
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Zip | 62521-9723
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Country | US
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Telephone | 217-864-1521
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Fax |
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Provider Business Mailing Address
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Address Line | 626 DUNN CIR
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City | SULLIVAN
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State | IL
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Zip | 61951-6398
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Country | US
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Telephone | 217-620-5520
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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 | 227.001810
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License Number State | IL
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