| Doctor Name: | JIM R KIMBAL |
| NPI Number: | 1114985322 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ATC, LAT, LMT, CSCS |
| License Number: | 227005348 |
| Business Practice Address: | 1650 Cowles Street Fmh Rehab Department Fairbanks, AK - 99701 |
| Business Phone Number: | 9074585670 |
| Business Fax Number: | |
| Mailing Address: | Po Box 74293, FAIRBANKS |
| State: | AK |
| Postal Code: | 997074293 |
| Phone Number: | 9074792526 |
| Fax Number: | |
| NPI Enumeration Date: | 05/04/2006 |
| NPI Last Update Date: | 03/31/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | 227005348 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |