Provider Demographics
NPI:1316244908
Name:KIM, MANUEL (PT)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 GOLDSBORO RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-5826
Mailing Address - Country:US
Mailing Address - Phone:301-244-9099
Mailing Address - Fax:
Practice Address - Street 1:6400 GOLDSBORO RD
Practice Address - Street 2:SUITE 340
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-5826
Practice Address - Country:US
Practice Address - Phone:301-244-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700018282225100000X
MD24566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist