Provider Demographics
NPI:1841415056
Name:PARK, SO YOUNG (PT)
Entity Type:Individual
Prefix:MS
First Name:SO YOUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S PARKER RD
Mailing Address - Street 2:#3-135
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1613
Mailing Address - Country:US
Mailing Address - Phone:303-283-0130
Mailing Address - Fax:303-283-0131
Practice Address - Street 1:2600 S PARKER RD
Practice Address - Street 2:#3-135
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1613
Practice Address - Country:US
Practice Address - Phone:303-283-0130
Practice Address - Fax:303-283-0131
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 7526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist