Provider Demographics
NPI:1588396501
Name:NEXT LEVEL LEGACY, LLC
Entity type:Organization
Organization Name:NEXT LEVEL LEGACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:973-319-4015
Mailing Address - Street 1:306 CREEK PARK DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5648
Mailing Address - Country:US
Mailing Address - Phone:973-319-4015
Mailing Address - Fax:
Practice Address - Street 1:8 LACKAWANNA PLZ STE A
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3604
Practice Address - Country:US
Practice Address - Phone:973-319-4015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty