MEDICARE: SUZANNE TERESA KIM

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	225700000X	Massage Therapist	21044	NC

General Provider Information

NPI Number	:	1811734346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE TERESA KIM

Provider Business Mailing Address
First Line	:	595 WINDING CREEK RD APT F
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5165
Country	:	US
Telephone Number	:	910-992-9566
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 FRANCAM DR STE 124
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-4500
Country	:	US
Telephone Number	:	910-229-3924
Fax Number	:

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

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	07/11/2024

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Directions to “ SUZANNE TERESA KIM ” Practice Location

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