Provider Demographics
NPI:1932522190
Name:HEO, SEONGYONG (DPT)
Entity Type:Individual
Prefix:
First Name:SEONGYONG
Middle Name:
Last Name:HEO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 158TH ST
Mailing Address - Street 2:APT 2E
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2506
Mailing Address - Country:US
Mailing Address - Phone:917-600-0189
Mailing Address - Fax:
Practice Address - Street 1:4105 158TH ST
Practice Address - Street 2:APT 2E
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2506
Practice Address - Country:US
Practice Address - Phone:917-600-0189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist