Individual
JIM R KIMBAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT, LMT, CSCS
Contact information
Practice address
1650 COWLES STREET, FMH REHAB DEPARTMENT, FAIRBANKS, AK 99701
(907) 458-5670
Mailing address
PO BOX 74293, FAIRBANKS, AK 99707-4293
(907) 479-2526
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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