Healthcare Provider Details

I. General information

NPI: 1437709912
Provider Name (Legal Business Name): MIN PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MINEOLA BLVD
MINEOLA NY
11501-4006
US

IV. Provider business mailing address

5 EASTERN DR
NEW HYDE PARK NY
11040-3439
US

V. Phone/Fax

Practice location:
  • Phone: 516-366-4321
  • Fax:
Mailing address:
  • Phone: 718-414-3869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KYEONGHWAN MIN
Title or Position: OWNER
Credential: PT, L.AC.
Phone: 718-414-3869