MEDICARE: DR. BIANCA BELLE BETHEL KIM PT, DPT, CEEAA

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	18357	MA

General Provider Information

NPI Number	:	1063751857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BIANCA BELLE BETHEL KIM PT, DPT, CEEAA

Provider Business Mailing Address
First Line	:	100 N BEACON ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02134-1928
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N BEACON ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02134-1928
Country	:	US
Telephone Number	:	617-943-6294
Fax Number	:

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

Provider Enumeration Date	:	02/13/2013
Last Update Date	:	05/20/2015

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