Provider Demographics
NPI:1063751857
Name:BETHEL KIM, BIANCA BELLE (PT, DPT, CEEAA)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:BELLE
Last Name:BETHEL KIM
Suffix:
Gender:F
Credentials:PT, DPT, CEEAA
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:BELLE
Other - Last Name:BETHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-1928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 N BEACON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1928
Practice Address - Country:US
Practice Address - Phone:617-943-6294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist