Provider Demographics
NPI:1144653486
Name:KIM, LEOPOLD BINN (PT)
Entity type:Individual
Prefix:
First Name:LEOPOLD
Middle Name:BINN
Last Name:KIM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 MCGINNIS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6672
Mailing Address - Country:US
Mailing Address - Phone:770-495-0610
Mailing Address - Fax:
Practice Address - Street 1:6920 MCGINNIS FERRY RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6672
Practice Address - Country:US
Practice Address - Phone:770-495-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist