Provider Demographics
NPI:1346957586
Name:KIM, PAUL (PTA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:12222 MERIT DR STE 320
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3221
Mailing Address - Country:US
Mailing Address - Phone:972-546-0411
Mailing Address - Fax:972-559-1867
Practice Address - Street 1:12222 MERIT DR STE 320
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3221
Practice Address - Country:US
Practice Address - Phone:972-546-0411
Practice Address - Fax:972-559-1867
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX2173296225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant