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General NPI Number Information
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NPI Number | 1821677634
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Entity Type | Organization
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Legal Business Name | JYL PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 8829 FRANCIS LEWIS BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-2243
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Country | US
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Telephone | 917-293-8329
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Fax |
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Provider Business Mailing Address
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Address Line | 17163 46TH AVE # 2RR
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City | FLUSHING
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State | NY
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Zip | 11358-3332
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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 | DOCTOR OF PHYSICAL THERAPY
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Name | JAEYOUNG LEE
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Credential |
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Telephone | 917-293-8329
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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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