Provider Demographics
NPI:1366856726
Name:JO, JONGIL (DPT)
Entity Type:Individual
Prefix:DR
First Name:JONGIL
Middle Name:
Last Name:JO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:JIMMY
Other - Middle Name:
Other - Last Name:JO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:136 E 57TH ST STE 801
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:347-200-7412
Mailing Address - Fax:
Practice Address - Street 1:136 E 57TH ST STE 801
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2971
Practice Address - Country:US
Practice Address - Phone:347-200-7412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist