Provider Demographics
NPI:1942618178
Name:LIM, BRANDON JIHOON (DPT, CMTPT)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JIHOON
Last Name:LIM
Suffix:
Gender:M
Credentials:DPT, CMTPT
Other - Prefix:
Other - First Name:JI
Other - Middle Name:HOON
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3595 FELS LN
Mailing Address - Street 2:APT 3203
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043
Mailing Address - Country:US
Mailing Address - Phone:443-545-7171
Mailing Address - Fax:443-535-6825
Practice Address - Street 1:8827 COLUMBIA 100 PKWY STE 1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:443-574-4250
Practice Address - Fax:443-535-6825
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist