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General NPI Number Information
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NPI Number | 1295992014
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Entity Type | Organization
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Legal Business Name | YOUNGS PHYSICAL THERAPY P C
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 1417 BELL BLVD
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City | BAYSIDE
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State | NY
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Zip | 11360-1211
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Country | US
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Telephone | 718-352-8010
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Fax | 718-352-8012
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Provider Business Mailing Address
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Address Line | 1417 BELL BLVD
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City | BAYSIDE
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State | NY
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Zip | 11360-1211
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Country | US
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Telephone | 718-352-8010
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Fax | 718-352-8012
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Authorized Official
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Title or Position | OWNER
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Name | YOUNGSOO OH
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Credential | P.T., L.AC
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Telephone | 718-352-8010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 03477
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 16067
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License Number State | NY
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