Provider Demographics
NPI:1669703005
Name:LIM, VICKI (LMT)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W PITKIN AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1509
Mailing Address - Country:US
Mailing Address - Phone:719-240-4417
Mailing Address - Fax:
Practice Address - Street 1:2403 SANTA FE DR
Practice Address - Street 2:SUITE 7
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81006-1497
Practice Address - Country:US
Practice Address - Phone:719-240-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4981172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist