Healthcare Provider Details

I. General information

NPI: 1477414811
Provider Name (Legal Business Name): ONE SOUL PHYSICAL THERAPY AND ACUPUNCTURE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SCHENCK AVE APT 2B
GREAT NECK NY
11021-3610
US

IV. Provider business mailing address

17 SCHENCK AVE APT 2B
GREAT NECK NY
11021-3610
US

V. Phone/Fax

Practice location:
  • Phone: 646-379-9994
  • Fax:
Mailing address:
  • Phone: 646-379-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: HYUNJONG KIM
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential:
Phone: 646-379-9994