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General NPI Number Information
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NPI Number | 1558383661
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Entity Type | Organization
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Legal Business Name | IN REHABILITATION AND WELLNESS PC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 464 HUDSON TER SUITE 204
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2917
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Country | US
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Telephone | 201-894-5451
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Fax | 201-894-5450
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Provider Business Mailing Address
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Address Line | 464 HUDSON TER SUITE 204
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2902
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Country | US
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Telephone | 201-894-5451
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Fax | 201-894-5450
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DAEGYUN KIM
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Credential | P.T.
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Telephone | 201-894-5451
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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 | 40QA01140100
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License Number State | NJ
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