Provider Demographics
NPI:1649694274
Name:BOEDIGHEIMER, KIM (CMT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BOEDIGHEIMER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 4TH AVE S APT 2
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-2255
Mailing Address - Country:US
Mailing Address - Phone:612-708-1468
Mailing Address - Fax:763-631-0460
Practice Address - Street 1:114A RUM RIVER DR N
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1762
Practice Address - Country:US
Practice Address - Phone:612-708-1468
Practice Address - Fax:763-631-0460
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist