Individual provider Active NPI

Patrick Kim, PT, DPT

  • Physical Therapist
  • New York, NY
National Provider Identifier
1255702817
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
037971 Issued in NY
Practice address
584 Broadway RM 710
New York, NY 10012-5242
Phone
(213) 273-6974
NPI assigned
Oct 8, 2015
Last updated
Mar 13, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 037971 NY Primary

Addresses

Primary practice location

584 Broadway RM 710
New York, NY 10012-5242

Mailing address

584 Broadway RM 710
New York, NY 10012-5242
Phone (212) 941-0503

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201201001690 NY Practitioner - Physical Therapist in Private Practice 5193010346 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
037971NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Physiofitness P.T., P.C. Physical Therapist CurrentSince Mar 22, 2020 Accepting new patients
New York Physical and Occupational Therapy Services, PLLC Physical Therapist CurrentSince Nov 20, 2020 Accepting new patients
RB Physical and Occupational Therapy PLLC Physical Therapist CurrentSince Jun 22, 2026 Accepting new patients
Gotham Physical Therapy Group PLLC Physical Therapist PastSince Aug 11, 2016 Accepting new patients

Locations

2579 Ocean Ave
Fl 3
Brooklyn, NY 11229
Phone (646) 780-0925

588 Broadway
Rm 710
New York, NY 10012
Phone (212) 804-9060

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1255702817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "584 BROADWAY RM 710",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100125242",
            "telephone_number": "212-941-0503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "584 BROADWAY RM 710",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100125242",
            "telephone_number": "213-273-6974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "PATRICK",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-08",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "037971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.