MEDICARE: ALEXANDER KIM DPT

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	2305215941	VA

General Provider Information

NPI Number	:	1952184640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER KIM DPT

Provider Business Mailing Address
First Line	:	7327 LAKE WALTON BLVD
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-8557
Country	:	US
Telephone Number	:	703-965-9882
Fax Number	:

Provider Business Practice Location Address
First Line	:	5718 SPOHN DR STE 100
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4265
Country	:	US
Telephone Number	:	361-906-2062
Fax Number	:

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

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	01/06/2025

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