MEDICARE: PATRICK KIM PT, 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	037971	NY

General Provider Information

NPI Number	:	1255702817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK KIM PT, DPT

Provider Business Mailing Address
First Line	:	584 BROADWAY RM 710
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-5242
Country	:	US
Telephone Number	:	212-941-0503
Fax Number	:

Provider Business Practice Location Address
First Line	:	584 BROADWAY RM 710
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-5242
Country	:	US
Telephone Number	:	213-273-6974
Fax Number	:

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

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	03/13/2020

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Directions to “ PATRICK KIM PT, DPT” Practice Location

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