Provider Demographics
NPI:1770837957
Name:PROFESSIONAL PHYSICAL THERAPY & REHABILITATION PC
Entity Type:Organization
Organization Name:PROFESSIONAL PHYSICAL THERAPY & REHABILITATION PC
Other - Org Name:PROFESSIONAL PHYSICAL THERAPY & REHABILITATION PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EUNHYE
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-759-6500
Mailing Address - Street 1:14370 SANFORD AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-886-2078
Mailing Address - Fax:718-886-2109
Practice Address - Street 1:42-12, 164TH ST 1FL
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358
Practice Address - Country:US
Practice Address - Phone:718-701-5500
Practice Address - Fax:718-888-1524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty