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General NPI Number Information
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NPI Number | 1841720950
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Entity Type | Organization
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Legal Business Name | JWC PT PC
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 20935 NORTHERN BLVD STE 215
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City | BAYSIDE
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State | NY
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Zip | 11361-3134
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Country | US
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Telephone | 718-225-9000
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Fax | 718-352-9000
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Provider Business Mailing Address
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Address Line | 20935 NORTHERN BLVD STE 215
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City | BAYSIDE
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State | NY
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Zip | 11361-3134
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Country | US
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Telephone | 718-225-9000
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Fax | 718-352-9000
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | JAEWOOK CHOI
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Credential | DPT
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Telephone | 347-256-1455
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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 | 031918
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License Number State | NY
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