Provider Demographics
NPI:1750486882
Name:LIM, BRIGIT LORRAINE MOORE (MPT)
Entity type:Individual
Prefix:MRS
First Name:BRIGIT
Middle Name:LORRAINE MOORE
Last Name:LIM
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:BRIGIT
Other - Middle Name:LORRAINE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:115 NATOMA STREET
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:115 NATOMA STREET
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-355-8500
Practice Address - Fax:916-781-5187
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q65593Medicare UPIN
0PT324040Medicare ID - Type Unspecified