MEDICARE: YK MOVEMENT 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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1952006157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YK MOVEMENT PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	5629 CLOVERDALE BLVD
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11364-2047
Country	:	US
Telephone Number	:	201-312-5797
Fax Number	:	347-502-6030

Provider Business Practice Location Address
First Line	:	7011 108TH ST APT 1J
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4405
Country	:	US
Telephone Number	:	201-312-5797
Fax Number	:	347-502-6030

Authorized Official
Title or Position	:	DPT/PRESIDENT
Name	:	YOUNG DONG KIM
Credential	:
Telephone Number	:	201-312-5797

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	04/05/2023

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