Provider Demographics
NPI:1689439812
Name:JUNG, MICHAEL (DPT,PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:DPT,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6529
Mailing Address - Country:US
Mailing Address - Phone:401-302-5822
Mailing Address - Fax:
Practice Address - Street 1:187 SUMMER ST STE 3
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1245
Practice Address - Country:US
Practice Address - Phone:401-648-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27378261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy