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General NPI Number Information
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NPI Number | 1093902777
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Entity Type | Individual
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Provider Name | MINA KIM PT
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Gender | Female
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 3310 FALL HILL AVE
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3000
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Country | US
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Telephone | 540-373-4602
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Fax |
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Provider Business Mailing Address
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Address Line | 1203 PERRY ST
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-2619
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Country | US
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Telephone | 443-255-0088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 21506
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305205881
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License Number State | VA
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