Provider Demographics
NPI:1003055898
Name:KIM, CORTLAND ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:CORTLAND
Middle Name:ROBERT
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 1:3019 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3314
Mailing Address - Country:US
Mailing Address - Phone:415-387-6564
Mailing Address - Fax:415-387-2013
Practice Address - Street 1:3019 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3314
Practice Address - Country:US
Practice Address - Phone:415-387-6564
Practice Address - Fax:415-387-2013
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist