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General NPI Number Information
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NPI Number | 1477013522
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Entity Type | Individual
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Provider Name | KIMBERLY ANDERSEN
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Gender | Female
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Dates
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Enumeration Date | 03/24/2019
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Last Update Date | 03/24/2019
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Provider Practice Location Address
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Address Line | 5069 W 13400 S STE 100
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City | RIVERTON
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State | UT
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Zip | 84096-6603
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Country | US
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Telephone | 801-253-8141
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Fax |
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Provider Business Mailing Address
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Address Line | 13767 S MONTE JOSEPH DR
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City | HERRIMAN
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State | UT
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Zip | 84096-6890
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Country | US
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Telephone |
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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 | 10474887-4701
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License Number State | UT
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