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General NPI Number Information
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NPI Number | 1093141533
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Entity Type | Organization
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Legal Business Name | STANLEY PARK PHYSICAL THERAPY, P.C.
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 03/02/2025
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Provider Practice Location Address
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Address Line | 4711 BELL BLVD
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City | BAYSIDE
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State | NY
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Zip | 11361-3333
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Country | US
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Telephone | 718-423-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 370 HILLSIDE AVE
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City | WILLISTON PARK
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State | NY
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Zip | 11596-2106
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Country | US
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Telephone | 718-423-5100
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Fax | 718-423-4105
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/PRESIDENT
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Name | SEJOONG PARK
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Credential | D.P.T.
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Telephone | 718-423-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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