Individual
BRANDON KIMBALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2409 S RURAL RD STE D, TEMPE, AZ 85282-2447
(480) 966-1635
Mailing address
1173 LAKE PARKE DR, SAINT JOHNS, FL 32259-3025
(904) 254-8447
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
MA48778
FL
225700000X
Massage Therapist
Primary
MT-25350
AZ
Other
Enumeration date
09/30/2010
Last updated
08/11/2020
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