Provider Demographics
NPI:1437320330
Name:SEUNGYOUL YI PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:SEUNGYOUL YI PHYSICAL THERAPY PC
Other - Org Name:DAE WON REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SEUNGYOUL
Authorized Official - Middle Name:
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:917-848-0936
Mailing Address - Street 1:PO BOX 130086
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-0981
Mailing Address - Country:US
Mailing Address - Phone:212-343-8210
Mailing Address - Fax:212-343-8211
Practice Address - Street 1:168 CANAL ST STE 312
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4503
Practice Address - Country:US
Practice Address - Phone:212-343-8210
Practice Address - Fax:212-343-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024761261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy