Provider Demographics
NPI:1184937294
Name:KIM, NANCY (MA, PT)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SHOREWARD DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2514
Mailing Address - Country:US
Mailing Address - Phone:516-472-0121
Mailing Address - Fax:
Practice Address - Street 1:117 SHOREWARD DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2514
Practice Address - Country:US
Practice Address - Phone:516-472-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015166-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics