Provider Demographics
NPI:1689414930
Name:BAILEY, KIMBERLY (CMT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BAILEY
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 1:1120 2ND ST STE C
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2225
Mailing Address - Country:US
Mailing Address - Phone:925-494-1303
Mailing Address - Fax:
Practice Address - Street 1:1120 2ND ST STE C
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2225
Practice Address - Country:US
Practice Address - Phone:925-494-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26581225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist