Provider Demographics
NPI:1699593921
Name:PARK, SEONGYEOL (PT, DPT)
Entity type:Individual
Prefix:
First Name:SEONGYEOL
Middle Name:
Last Name:PARK
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BOSCO
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:440 SYLVAN AVE STE 135
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2736
Mailing Address - Country:US
Mailing Address - Phone:201-566-6398
Mailing Address - Fax:201-367-3482
Practice Address - Street 1:440 SYLVAN AVE STE 135
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2736
Practice Address - Country:US
Practice Address - Phone:201-566-6398
Practice Address - Fax:201-367-3482
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02292500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist