Healthcare Provider Details

I. General information

NPI: 1457440356
Provider Name (Legal Business Name): CHRISTY KIM P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WALL ST
WEST LONG BRANCH NJ
07764-1181
US

IV. Provider business mailing address

865 E 9TH ST
BROOKLYN NY
11230-2809
US

V. Phone/Fax

Practice location:
  • Phone: 732-222-8556
  • Fax: 732-222-8663
Mailing address:
  • Phone: 718-692-4926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025555-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: