Provider Demographics
NPI:1457440356
Name:KIM, CHRISTY (PT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:
Last Name:KIM
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 1:865 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2809
Mailing Address - Country:US
Mailing Address - Phone:718-692-4926
Mailing Address - Fax:
Practice Address - Street 1:240 WALL ST
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1181
Practice Address - Country:US
Practice Address - Phone:732-222-8556
Practice Address - Fax:732-222-8663
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025555-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist