Provider Demographics
NPI:1679069306
Name:ADAMS, KIMBERLY S (LMT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1887 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-9021
Mailing Address - Country:US
Mailing Address - Phone:937-689-7760
Mailing Address - Fax:937-405-1078
Practice Address - Street 1:3060 DAYTON XENIA RD STE C
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6393
Practice Address - Country:US
Practice Address - Phone:937-427-2225
Practice Address - Fax:937-405-1078
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17653225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty