Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1355481 | TX |
NPI | 1265199129 |
---|---|
Provider Name | Dr. Stephanie Kim |
First Address | Dallas, TX 75209-6445 |
Second Address | Dallas, TX 75246-1520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2021 |
Last Update Date | 25/11/2021 |