Provider Demographics
NPI:1639434673
Name:YOO, SEUNG JO (DPT)
Entity Type:Individual
Prefix:DR
First Name:SEUNG JO
Middle Name:
Last Name:YOO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 CLINTONVILLE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3814
Mailing Address - Country:US
Mailing Address - Phone:917-612-3939
Mailing Address - Fax:718-830-0005
Practice Address - Street 1:9811 QUEENS BLVD STE 1E
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3309
Practice Address - Country:US
Practice Address - Phone:718-830-0400
Practice Address - Fax:718-830-0005
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03681096Medicaid