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Individual

DIANE KIM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
25727 NE STATE ROAD 26, MELROSE, FL 32666-6202
(352) 475-3113
Mailing address
579 OAKMONT DR, ORANGE PARK, FL 32073-6739

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA29506
FL

Other

Enumeration date
07/22/2019
Last updated
07/22/2019
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