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NPI Code Detail

MEDICARE: WELLNESS OF WALL STREET PHYSICAL THERAPY, P.C.

MEDICARE: WELLNESS OF WALL STREET 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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1881401107
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLNESS OF WALL STREET PHYSICAL THERAPY, P.C.
Provider Business Mailing Address
First Line : 42 BROADWAY STE 1219
Second Line :
City : NEW YORK
State : NY
Zip : 10004-3834
Country : US
Telephone Number : 929-412-2654
Fax Number : 929-412-2686
Provider Business Practice Location Address
First Line : 42 BROADWAY STE 1219
Second Line :
City : NEW YORK
State : NY
Zip : 10004-3834
Country : US
Telephone Number : 929-412-2654
Fax Number : 929-412-2686
Authorized Official
Title or Position : PRESIDENT
Name : DONGHWAN PARK
Credential :
Telephone Number : 929-412-2654
Provider Enumeration Date : 12/11/2024
Last Update Date : 12/11/2024

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Directions to “WELLNESS OF WALL STREET PHYSICAL THERAPY, P.C. ” Practice Location

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