Provider Demographics
NPI:1225267909
Name:LIM, VICENTE M
Entity Type:Individual
Prefix:
First Name:VICENTE
Middle Name:M
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FARM ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-6698
Mailing Address - Country:US
Mailing Address - Phone:203-594-5200
Mailing Address - Fax:203-594-5412
Practice Address - Street 1:3 FARM ROAD
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-6698
Practice Address - Country:US
Practice Address - Phone:203-594-5200
Practice Address - Fax:203-594-5412
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist