Provider Demographics
NPI:1831784727
Name:LIM, QUEENIE (PT)
Entity type:Individual
Prefix:
First Name:QUEENIE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9370 STUDIO CT STE 130
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8048
Mailing Address - Country:US
Mailing Address - Phone:916-714-1177
Mailing Address - Fax:
Practice Address - Street 1:9370 STUDIO CT STE 130
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8048
Practice Address - Country:US
Practice Address - Phone:916-714-1177
Practice Address - Fax:916-714-3577
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT299956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT299956OtherPHYSICAL THERAPY BOARD OF CALIFORNIA