Provider Demographics
NPI:1225571185
Name:LIM, ANDREW (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SAINT PATRICKS DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4527
Mailing Address - Country:US
Mailing Address - Phone:301-870-7366
Mailing Address - Fax:301-870-6717
Practice Address - Street 1:60 MARKET ST
Practice Address - Street 2:SUITE 206
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6548
Practice Address - Country:US
Practice Address - Phone:301-990-9599
Practice Address - Fax:301-990-2899
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist