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General NPI Number Information
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NPI Number | 1740480201
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Entity Type | Organization
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Legal Business Name | Y H PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 4109 108TH STREET
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City | CORONA
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State | NY
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Zip | 11368
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Country | US
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Telephone | 718-205-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 4109 108TH STREET
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City | CORONA
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State | NY
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Zip | 11368
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Country | US
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Telephone | 718-205-2233
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. YOUNG SEOK PARK
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Credential | PHYSICAL THERAPIST
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Telephone | 516-627-0798
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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 | 017070
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License Number State | NY
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