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General NPI Number Information
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NPI Number | 1194305961
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Entity Type | Individual
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Provider Name | KYOUNG MIN PARK
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Gender | Female
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 1783 SW 3RD AVE
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City | MIAMI
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State | FL
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Zip | 33129-1493
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Country | US
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Telephone | 786-495-0305
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Fax |
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Provider Business Mailing Address
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Address Line | 255 SW 11TH ST APT 1409
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City | MIAMI
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State | FL
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Zip | 33130-4197
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Country | US
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Telephone | 703-401-7459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT36892
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License Number State | FL
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