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General NPI Number Information
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NPI Number | 1871461905
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Entity Type | Individual
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Provider Name | KIMBERLY DANTZLER
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Gender | Female
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 8008 SHIP ST APT 204
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City | CHARLOTTE
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State | NC
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Zip | 28269-2796
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Country | US
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Telephone | 615-293-5090
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Fax |
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Provider Business Mailing Address
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Address Line | 3752 KINCAID BRIDGE RD
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City | WINNSBORO
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State | SC
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Zip | 29180-8064
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Country | US
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Telephone | 615-293-5090
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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 | 18167
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License Number State | NC
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