Provider Demographics
NPI:1760022347
Name:DR. THEODORE LIM, DPT, PLLC
Entity Type:Organization
Organization Name:DR. THEODORE LIM, DPT, PLLC
Other - Org Name:THE KILO PHYSIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:562-676-5501
Mailing Address - Street 1:4603 CAYMEN PL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3730
Mailing Address - Country:US
Mailing Address - Phone:562-676-5501
Mailing Address - Fax:
Practice Address - Street 1:3900 DROSSETT DR STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-1132
Practice Address - Country:US
Practice Address - Phone:562-676-5501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty