MEDICARE: KIMBERLY KOONTZ LMP

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	MA60140830	WA

General Provider Information

NPI Number	:	1184148066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY KOONTZ LMP

Provider Business Mailing Address
First Line	:	410 BELLEVUE WAY SE STE 202
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-6649
Country	:	US
Telephone Number	:	425-378-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 BELLEVUE WAY SE STE 202
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-6649
Country	:	US
Telephone Number	:	425-378-1800
Fax Number	:	425-462-1802

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

Provider Enumeration Date	:	08/01/2017
Last Update Date	:	07/21/2022

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Directions to “ KIMBERLY KOONTZ LMP” Practice Location

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