Provider Demographics
NPI:1396983706
Name:LIM, JANUARY ANNE (PT)
Entity type:Individual
Prefix:
First Name:JANUARY
Middle Name:ANNE
Last Name:LIM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8900 KEYSTONE XING
Mailing Address - Street 2:SUITE 600
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-7670
Mailing Address - Country:US
Mailing Address - Phone:317-218-0652
Mailing Address - Fax:866-931-9163
Practice Address - Street 1:8900 KEYSTONE XING
Practice Address - Street 2:SUITE 600
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-7670
Practice Address - Country:US
Practice Address - Phone:317-218-0652
Practice Address - Fax:866-931-9163
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009707A225100000X
CO9500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist