Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT019924 | PA |
NPI | 1043544760 |
---|---|
Provider Name | Mrs. Nina Kim |
First Address | Lancaster, PA 17603-4604 |
Second Address | Lancaster, PA 17603-4604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2009 |
Last Update Date | 28/09/2009 |