MEDICARE: KIMBERLY N EVERETT LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA103544	FL

General Provider Information

NPI Number	:	1093537771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY N EVERETT LMT

Provider Business Mailing Address
First Line	:	2217 KENDALL SPRINGS CT APT 201
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-2528
Country	:	US
Telephone Number	:	305-951-5809
Fax Number	:

Provider Business Practice Location Address
First Line	:	722 W MLK BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-3133
Country	:	US
Telephone Number	:	305-951-5809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2024
Last Update Date	:	12/18/2024

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Directions to “ KIMBERLY N EVERETT LMT” Practice Location

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