Provider Demographics
NPI:1588214381
Name:GOOD PHYSIO CLINIC INC
Entity Type:Organization
Organization Name:GOOD PHYSIO CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-937-2934
Mailing Address - Street 1:701 COTTAGE GROVE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3080
Mailing Address - Country:US
Mailing Address - Phone:860-318-5682
Mailing Address - Fax:860-318-5682
Practice Address - Street 1:701 COTTAGE GROVE RD STE 110
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3080
Practice Address - Country:US
Practice Address - Phone:860-318-5682
Practice Address - Fax:860-318-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy