=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285971986
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOCTOR PHYSICAL THERAPY,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2013
-----------------------------------------------------
Last Update Date | 01/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 WASHINGTON ST SUITE 104
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02445-7130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-731-1004
-----------------------------------------------------
Fax | 617-731-1001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44 WASHINGTON ST SUITE 104
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02445-7130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-731-1004
-----------------------------------------------------
Fax | 617-731-1001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. CHANG YOON
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 617-731-1004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 18660
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------