Provider Demographics
NPI:1447931647
Name:NAVARRO, KIMBERLY (LMT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 RIDGE RUN SE APT R
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8225
Mailing Address - Country:US
Mailing Address - Phone:678-791-8930
Mailing Address - Fax:
Practice Address - Street 1:139 VILLAGE CTR W STE 110
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5434
Practice Address - Country:US
Practice Address - Phone:676-744-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT009581225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist