Provider Demographics
NPI:1770030835
Name:KHONG, TARYN TAMIKO MANO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:TAMIKO MANO
Last Name:KHONG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:TAMIKO
Other - Last Name:MANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:53 COLUMBUS AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:53 COLUMBUS AVE STE 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6909
Practice Address - Country:US
Practice Address - Phone:212-541-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist