Provider Demographics
NPI:1972038974
Name:PYO, HYUN GYUNG (PTA)
Entity Type:Individual
Prefix:MRS
First Name:HYUN
Middle Name:GYUNG
Last Name:PYO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:HYUN
Other - Middle Name:GUNG
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2930 W. HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURY
Mailing Address - State:OR
Mailing Address - Zip Code:97471
Mailing Address - Country:US
Mailing Address - Phone:541-784-7771
Mailing Address - Fax:541-672-1466
Practice Address - Street 1:2930 W HARVARD AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURY
Practice Address - State:OR
Practice Address - Zip Code:97471
Practice Address - Country:US
Practice Address - Phone:541-784-7771
Practice Address - Fax:541-672-1466
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant