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General NPI Number Information
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NPI Number | 1316131303
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Entity Type | Organization
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Legal Business Name | KOAM PHYSICAL THERAPY, P.C.
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Dates
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Enumeration Date | 09/01/2007
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 16410 NORTHERN BLVD STE 201
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City | FLUSHING
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State | NY
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Zip | 11358-2668
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Country | US
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Telephone | 718-463-2700
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Fax | 718-463-6174
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Provider Business Mailing Address
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Address Line | 16410 NORTHERN BLVD STE 201
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City | FLUSHING
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State | NY
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Zip | 11358-2668
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Country | US
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Telephone | 718-463-2700
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Fax | 718-463-6174
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Authorized Official
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Title or Position | PRESIDENT
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Name | SOON OK KIM
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Credential | P.T.
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Telephone | 718-463-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 021153
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License Number State | NY
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