Provider Demographics
NPI:1225176027
Name:PARK, EUNHA K (RPT)
Entity Type:Individual
Prefix:MRS
First Name:EUNHA
Middle Name:K
Last Name:PARK
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:PO BOX 412307
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8040
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:
Practice Address - Street 1:10504 WAKEMAN DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-8040
Practice Address - Country:US
Practice Address - Phone:540-891-5326
Practice Address - Fax:540-891-6316
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA650000166Medicare ID - Type UnspecifiedMEDICARE NUMBER
VAS16945Medicare UPIN