Provider Demographics
NPI:1841597648
Name:MT ZION PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MT ZION PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KI TAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAENG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-321-3962
Mailing Address - Street 1:14627 BEECH AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2172
Mailing Address - Country:US
Mailing Address - Phone:718-321-3962
Mailing Address - Fax:718-321-3965
Practice Address - Street 1:14627 BEECH AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2172
Practice Address - Country:US
Practice Address - Phone:718-321-3962
Practice Address - Fax:718-321-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty