Provider Demographics
NPI:1568612992
Name:PARK, HYUN JOO (DPT)
Entity Type:Individual
Prefix:
First Name:HYUN
Middle Name:JOO
Last Name:PARK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BRIDGE PLZ N
Mailing Address - Street 2:FORT LEE PHYSICAL THERAPY
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5059
Mailing Address - Country:US
Mailing Address - Phone:201-585-7300
Mailing Address - Fax:201-585-7301
Practice Address - Street 1:301 BRIDGE PLZ N
Practice Address - Street 2:FORT LEE PHYSICAL THERAPY
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5059
Practice Address - Country:US
Practice Address - Phone:201-585-7300
Practice Address - Fax:201-585-7301
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01267000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist