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General NPI Number Information
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NPI Number | 1164040838
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Entity Type | Individual
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Provider Name | GINA KIM PT, DPT, LMT
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Gender | Female
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 1496 OLD HENDERSON RD RM 7
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City | COLUMBUS
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State | OH
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Zip | 43220-3614
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Country | US
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Telephone | 614-353-1581
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Fax |
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Provider Business Mailing Address
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Address Line | 580 THORNGATE CT
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City | GALLOWAY
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State | OH
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Zip | 43119-8324
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Country | US
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Telephone |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 33.026213
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License Number State | OH
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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 | PT017953
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License Number State | OH
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