Provider Demographics
NPI:1467673632
Name:LIM, MARLON (PT)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:LIM
Suffix:
Gender:M
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:PO BOX 7594
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0594
Mailing Address - Country:US
Mailing Address - Phone:252-443-0808
Mailing Address - Fax:252-451-9032
Practice Address - Street 1:1223 JULIAN R ALLSBROOK HWY
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-5126
Practice Address - Country:US
Practice Address - Phone:252-537-1215
Practice Address - Fax:252-537-1816
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2504211OtherMEDICARE - CPTA
NC2504211AOtherMEDICARE - WOSNC
NC7212481Medicaid
078UWOtherBCBS