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General NPI Number Information
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NPI Number | 1669169108
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Entity Type | Organization
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Legal Business Name | CORE BALANCE PHYSICAL THERAPY, P.C.
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 4029 235TH ST FL 2
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City | DOUGLASTON
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State | NY
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Zip | 11363-1509
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Country | US
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Telephone | 718-359-1004
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Fax | 718-691-4053
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Provider Business Mailing Address
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Address Line | 4029 235TH ST FL 2
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City | DOUGLASTON
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State | NY
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Zip | 11363-1509
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Country | US
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Telephone | 718-359-1004
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Fax | 718-691-4053
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WOOYOUNG BAE
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Credential | DPT
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Telephone | 929-225-3210
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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 |
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License Number State |
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