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NPI Code Detail

MEDICARE: LAON PHYSICAL THERAPY PC

MEDICARE: LAON PHYSICAL THERAPY PC
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
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518522085
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAON PHYSICAL THERAPY PC
Provider Business Mailing Address
First Line : 13620 MAPLE AVE STE 201C
Second Line :
City : FLUSHING
State : NY
Zip : 11355-5167
Country : US
Telephone Number : 929-398-3120
Fax Number : 833-985-0130
Provider Business Practice Location Address
First Line : 4199 MAIN ST STE 202B
Second Line :
City : FLUSHING
State : NY
Zip : 11355-5164
Country : US
Telephone Number : 929-398-3120
Fax Number : 833-985-0130
Authorized Official
Title or Position : DOCTOR OF PHYSICAL THERAPIST
Name : JEAGWAN LIM
Credential :
Telephone Number : 929-600-4257
Provider Enumeration Date : 05/09/2019
Last Update Date : 04/26/2024

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Directions to “LAON PHYSICAL THERAPY PC ” Practice Location

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