Individual
MRS. LISA M. KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1615 WINSTED DR, SUITE 3, GOSHEN, IN 46526-4696
(574) 534-4648
(574) 537-9048
Mailing address
65545 BARRENS DR, GOSHEN, IN 46526-6430
(574) 533-9727
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06002626A
IN
Other
Enumeration date
05/31/2007
Last updated
01/05/2011
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