Provider Demographics
NPI:1942693031
Name:FLUSHING PHYSICAL THERAPY WELLNESS PC
Entity Type:Organization
Organization Name:FLUSHING PHYSICAL THERAPY WELLNESS 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:718-353-7575
Mailing Address - Street 1:14226 37TH AVE
Mailing Address - Street 2:#C BASEMENT
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4103
Mailing Address - Country:US
Mailing Address - Phone:718-353-7575
Mailing Address - Fax:718-353-7576
Practice Address - Street 1:14226 37TH AVE
Practice Address - Street 2:#C BASEMENT
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4103
Practice Address - Country:US
Practice Address - Phone:718-353-7575
Practice Address - Fax:718-353-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty