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General NPI Number Information
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NPI Number | 1184430274
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Entity Type | Organization
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Legal Business Name | GREENERY PHYSICAL THERAPY, P.C.
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 1 BARSTOW RD STE P14
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City | GREAT NECK
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State | NY
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Zip | 11021-3510
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Country | US
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Telephone | 917-213-3287
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Fax |
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Provider Business Mailing Address
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Address Line | 2 BLUE SLIP APT 12B
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City | BROOKLYN
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State | NY
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Zip | 11222-7294
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHANGMIN HAN
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Credential | PT, DPT, MS
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Telephone | 917-213-3287
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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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