=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124562236
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORE STATION PHYSICAL THERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2016
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 WEST ST # 2
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10990-3214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-545-4803
-----------------------------------------------------
Fax | 845-853-1598
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 214 WEST ST # 2
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10990-3214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-545-4803
-----------------------------------------------------
Fax | 845-853-1598
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST/FOUNDER
-----------------------------------------------------
Name | DR. TAEWOON HA
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 845-545-4803
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 035519
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------