Provider Demographics
NPI:1841022597
Name:KIM, BARZILLAI (PT)
Entity type:Individual
Prefix:DR
First Name:BARZILLAI
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:DR
Other - First Name:BARZ
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:6420 KOFFEL CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7065
Mailing Address - Country:US
Mailing Address - Phone:301-332-2754
Mailing Address - Fax:
Practice Address - Street 1:1033 S EDGEWOOD ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4813
Practice Address - Country:US
Practice Address - Phone:703-884-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACP033533T225100000X
MD30115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist