MEDICARE: JUNMIN PARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	PTH11401	AL

General Provider Information

NPI Number	:	1497430623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNMIN PARK

Provider Business Mailing Address
First Line	:	7850 VAUGHN RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-1333
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7850 VAUGHN RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-1333
Country	:	US
Telephone Number	:	334-396-2110
Fax Number	:	334-396-2115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	06/15/2023

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Directions to “ JUNMIN PARK ” Practice Location

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