Provider Demographics
NPI:1386275220
Name:FIT INTO PT PC
Entity type:Organization
Organization Name:FIT INTO PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEONGWOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:SO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-460-1090
Mailing Address - Street 1:416 WHITE ROSE LN
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2543
Mailing Address - Country:US
Mailing Address - Phone:646-460-1090
Mailing Address - Fax:
Practice Address - Street 1:416 WHITE ROSE LN
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2543
Practice Address - Country:US
Practice Address - Phone:646-290-7099
Practice Address - Fax:646-290-7059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty