Provider Demographics
NPI:1093969446
Name:SEJONG PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:SEJONG PHYSICAL THERAPY INC
Other - Org Name:SEJONG MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:678-206-0808
Mailing Address - Street 1:1325 SATELLITE BLVD NW STE 1402
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4667
Mailing Address - Country:US
Mailing Address - Phone:678-206-0808
Mailing Address - Fax:
Practice Address - Street 1:1325 SATELLITE BLVD NW STE 1402
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4667
Practice Address - Country:US
Practice Address - Phone:678-206-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies