MEDICARE: KIMBERLY BORELL LMT CMLDT

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	MT125917	TX

General Provider Information

NPI Number	:	1891641510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BORELL LMT CMLDT

Provider Business Mailing Address
First Line	:	10506 SPRING VALLEY RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78737-1917
Country	:	US
Telephone Number	:	512-578-6634
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 DICKSON DR STE 22
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-4788
Country	:	US
Telephone Number	:	512-956-8695
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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