Provider Demographics
NPI:1720812977
Name:GREEN LEAF PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:GREEN LEAF PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BYEUNGGUK
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:646-777-2078
Mailing Address - Street 1:501 5TH AVE RM 1204
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-7873
Mailing Address - Country:US
Mailing Address - Phone:646-777-2078
Mailing Address - Fax:646-777-2057
Practice Address - Street 1:501 5TH AVE RM 1204
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-7873
Practice Address - Country:US
Practice Address - Phone:646-777-2078
Practice Address - Fax:646-777-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy