Provider Demographics
NPI:1760032833
Name:NOTICE, KIMBERLY (LMT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:NOTICE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:69 ESSEX CT
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1068
Mailing Address - Country:US
Mailing Address - Phone:347-419-8087
Mailing Address - Fax:
Practice Address - Street 1:1825 LIMEKILN PIKE STE 5
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1739
Practice Address - Country:US
Practice Address - Phone:215-646-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG009319225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist