MEDICARE: KIM KLING 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	261QH0100X	Health Service Clinic/Center	MA51014	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA51014	OTHER	FL	LIC MASSAGE THERAPY

General Provider Information

NPI Number	:	1497179196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIM KLING LMT

Provider Business Mailing Address
First Line	:	2449 S RIDGEWOOD AVE
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-3077
Country	:	US
Telephone Number	:	386-258-2162
Fax Number	:

Provider Business Practice Location Address
First Line	:	2449 S RIDGEWOOD AVE
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-3077
Country	:	US
Telephone Number	:	386-258-2162
Fax Number	:

Authorized Official
Title or Position	:	MASSAGE THERAPY
Name	:	MS. KIM SAYLON KLING
Credential	:	LMT
Telephone Number	:	386-258-2162

Provider Enumeration Date	:	02/15/2014
Last Update Date	:	02/15/2014

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Directions to “KIM KLING LMT ” Practice Location

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