Provider Demographics
NPI:1518479807
Name:WELCOME HOME PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:WELCOME HOME PHYSICAL THERAPY, P.C.
Other - Org Name:WELCOME HOME PHYSICAL THERAPY, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAECHOL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-600-3291
Mailing Address - Street 1:21133 46TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3313
Mailing Address - Country:US
Mailing Address - Phone:646-600-3291
Mailing Address - Fax:
Practice Address - Street 1:4373 UNION ST UNIT 1B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3191
Practice Address - Country:US
Practice Address - Phone:718-461-9188
Practice Address - Fax:347-643-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty