Provider Demographics
NPI:1952015687
Name:EOM, MICHAEL WOOJIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WOOJIN
Last Name:EOM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:WOOJIN
Other - Last Name:RIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4404 SANSOM ST # 1F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2916
Mailing Address - Country:US
Mailing Address - Phone:919-622-3146
Mailing Address - Fax:
Practice Address - Street 1:2509 S 4TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-4712
Practice Address - Country:US
Practice Address - Phone:215-271-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT030367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist