Provider Demographics
NPI:1821161035
Name:PARK, YOOJIN (DPT)
Entity Type:Individual
Prefix:MS
First Name:YOOJIN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-2630
Mailing Address - Country:US
Mailing Address - Phone:540-735-0260
Mailing Address - Fax:540-735-0262
Practice Address - Street 1:195 FALCON DRIVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408
Practice Address - Country:US
Practice Address - Phone:540-735-0260
Practice Address - Fax:540-735-0262
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist