Provider Demographics
NPI:1962174714
Name:LIM, LUIS A (PT)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:LIM
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 1:2622 N 75TH CT APT G
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-1477
Mailing Address - Country:US
Mailing Address - Phone:773-550-0844
Mailing Address - Fax:
Practice Address - Street 1:2622 N 75TH CT APT G
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-1477
Practice Address - Country:US
Practice Address - Phone:773-550-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist