MEDICARE: OKKYUNG KIM PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	8548	FL
2	2251S0007X	Sports Physical Therapist	8548	FL

General Provider Information

NPI Number	:	1598099889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OKKYUNG KIM PT

Provider Business Mailing Address
First Line	:	1612 W WATERS AVE # 1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-2761
Country	:	US
Telephone Number	:	813-545-3851
Fax Number	:

Provider Business Practice Location Address
First Line	:	1612 W WATERS AVE # 1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-2761
Country	:	US
Telephone Number	:	813-545-3851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2009
Last Update Date	:	09/20/2009

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Directions to “ OKKYUNG KIM PT” Practice Location

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