Provider Demographics
NPI:1881188258
Name:PARK, HYUN HWA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HYUN
Middle Name:HWA
Last Name:PARK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HYUN
Other - Middle Name:HWA
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:11010 DAVID ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3481
Mailing Address - Country:US
Mailing Address - Phone:228-832-8327
Mailing Address - Fax:
Practice Address - Street 1:11010 DAVID ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503
Practice Address - Country:US
Practice Address - Phone:228-832-8327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist