Provider Demographics
NPI:1922020031
Name:HEALING HANDS PHYSICAL THERAPY & WELLNESS PLLC
Entity Type:Organization
Organization Name:HEALING HANDS PHYSICAL THERAPY & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPHIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAEGYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-317-9801
Mailing Address - Street 1:3453 RICHMOND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3219
Mailing Address - Country:US
Mailing Address - Phone:718-317-9801
Mailing Address - Fax:718-317-9802
Practice Address - Street 1:3453 RICHMOND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3219
Practice Address - Country:US
Practice Address - Phone:718-317-9801
Practice Address - Fax:718-317-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02646413Medicaid
NY02646413Medicaid