Provider Demographics
NPI:1679117881
Name:FLUSHING PHYSICAL THERAPY, CHIROPRACTIC, & ACUPUNCTURE, PLLC
Entity type:Organization
Organization Name:FLUSHING PHYSICAL THERAPY, CHIROPRACTIC, & ACUPUNCTURE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANGWOO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-746-4919
Mailing Address - Street 1:15001 NORTHERN BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3896
Mailing Address - Country:US
Mailing Address - Phone:718-746-4919
Mailing Address - Fax:718-746-4920
Practice Address - Street 1:15001 NORTHERN BLVD FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3896
Practice Address - Country:US
Practice Address - Phone:718-746-4919
Practice Address - Fax:718-746-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX009835OtherLICENSE