MEDICARE: KOAM PHYSICAL THERAPY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	021153	NY

General Provider Information

NPI Number	:	1316131303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOAM PHYSICAL THERAPY, P.C.

Provider Business Mailing Address
First Line	:	16410 NORTHERN BLVD STE 201
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-2668
Country	:	US
Telephone Number	:	718-463-2700
Fax Number	:	718-463-6174

Provider Business Practice Location Address
First Line	:	16410 NORTHERN BLVD STE 201
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-2668
Country	:	US
Telephone Number	:	718-463-2700
Fax Number	:	718-463-6174

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SOON OK KIM
Credential	:	P.T.
Telephone Number	:	718-463-2700

Provider Enumeration Date	:	09/01/2007
Last Update Date	:	11/01/2024

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