Provider Demographics
NPI:1740761402
Name:YOO, HAN NA (PT)
Entity Type:Individual
Prefix:DR
First Name:HAN
Middle Name:NA
Last Name:YOO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:HANNA
Other - Middle Name:
Other - Last Name:YOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:3620 BOWNE ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4501
Mailing Address - Country:US
Mailing Address - Phone:551-221-0657
Mailing Address - Fax:
Practice Address - Street 1:1 W 34TH ST RM 402
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-0071
Practice Address - Country:US
Practice Address - Phone:551-221-0657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400530317OtherMEDICARE PTAN
NYPT039471-8WOtherWORKERS COMPENSATION NUMBER