Provider Demographics
NPI:1063857522
Name:KLIM, MARILYN (PT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:KLIM
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 1:4 CASTLE GATE
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9171
Mailing Address - Country:US
Mailing Address - Phone:585-377-4600
Mailing Address - Fax:
Practice Address - Street 1:159 W MAIN ST
Practice Address - Street 2:LOWER LEVEL EAST
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2960
Practice Address - Country:US
Practice Address - Phone:585-872-9669
Practice Address - Fax:585-872-9449
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024245-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist