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General NPI Number Information
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NPI Number | 1124776307
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Entity Type | Organization
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Legal Business Name | JI PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 6308 ROOSEVELT AVE
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City | WOODSIDE
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State | NY
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Zip | 11377-3642
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Country | US
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Telephone | 347-209-3684
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Fax |
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Provider Business Mailing Address
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Address Line | 14021 32ND AVE APT 6CN
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City | FLUSHING
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State | NY
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Zip | 11354-2640
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Country | US
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Telephone | 347-209-3684
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Fax |
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Authorized Official
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Title or Position | PT
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Name | BONGHAK JI
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Credential |
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Telephone | 347-209-3684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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