Healthcare Provider Details

I. General information

NPI: 1124800552
Provider Name (Legal Business Name): SH PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4324 215TH ST FL 1
BAYSIDE NY
11361-2973
US

IV. Provider business mailing address

4324 215TH ST FL 1
BAYSIDE NY
11361-2973
US

V. Phone/Fax

Practice location:
  • Phone: 646-691-6447
  • Fax: 516-985-7850
Mailing address:
  • Phone: 516-537-9639
  • Fax: 516-985-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SEUNGYOUNG HAN
Title or Position: EMPLOYER
Credential:
Phone: 646-691-6447