Healthcare Provider Details

I. General information

NPI: 1770837957
Provider Name (Legal Business Name): PROFESSIONAL PHYSICAL THERAPY & REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 FLOWER LN
JERICHO NY
11753-2312
US

IV. Provider business mailing address

42 FLOWER LN
JERICHO NY
11753-2312
US

V. Phone/Fax

Practice location:
  • Phone: 201-759-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number032168
License Number StateNY

VIII. Authorized Official

Name: EUNHYE KO
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 201-759-6500