Provider Demographics
NPI:1619411253
Name:BEAUTIFUL LIFE REHAB PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:BEAUTIFUL LIFE REHAB PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEONGYONG
Authorized Official - Middle Name:
Authorized Official - Last Name:HEO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-841-7392
Mailing Address - Street 1:56 W 39TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-3824
Mailing Address - Country:US
Mailing Address - Phone:212-245-2122
Mailing Address - Fax:212-245-2112
Practice Address - Street 1:56 W 39TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3824
Practice Address - Country:US
Practice Address - Phone:212-245-2122
Practice Address - Fax:212-245-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty