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General NPI Number Information
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NPI Number | 1417553520
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Entity Type | Organization
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Legal Business Name | NEW CORPUS PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 12/05/2020
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Last Update Date | 12/05/2020
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Provider Practice Location Address
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Address Line | 1 W 34TH ST RM 402B
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City | NEW YORK
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State | NY
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Zip | 10001-3011
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Country | US
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Telephone | 332-207-0610
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Fax |
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Provider Business Mailing Address
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Address Line | 1 W 34TH ST RM 402B
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City | NEW YORK
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State | NY
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Zip | 10001-3011
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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 | PRESIDENT
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Name | YOUNGKI KONG
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Credential |
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Telephone | 929-328-4147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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