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Individual
JIM R KIMBAL
Active
Individual
JIM R KIMBAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT, LMT, CSCS
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
10650493-4810
UT
2255A2300X
Athletic Trainer
Primary
124560
AK
225700000X
Massage Therapist
117476
AK
225700000X
Massage Therapist
227005348
IL
Other
Enumeration date
05/04/2006
Last updated
09/28/2020
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