MEDICARE: KIMBERLY AKERSTROM LMT, MMP

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	MT131364	TX

General Provider Information

NPI Number	:	1538725767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY AKERSTROM LMT, MMP

Provider Business Mailing Address
First Line	:	503 WISE ST
Second Line	:
City	:	NEWARK
State	:	TX
Zip	:	76071-3828
Country	:	US
Telephone Number	:	817-476-0205
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 WISE ST
Second Line	:
City	:	NEWARK
State	:	TX
Zip	:	76071-3828
Country	:	US
Telephone Number	:	817-476-0205
Fax Number	:

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

Provider Enumeration Date	:	05/13/2019
Last Update Date	:	02/28/2020

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