| Organization Name: | GREEN PHYSICAL THERAPY P.C. |
| NPI Number: | 1073996534 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | YOUNG MI LEE (PRESIDENT) |
| Mailing Address: | 9711 101st Ave Ozone Park |
| State: | NY US |
| Postal Code: | 114162523 |
| Phone Number: | 7188458325 |
| Fax Number: | 8664636125 |
| NPI Enumeration Date: | 07/02/2015 |
| NPI Last Update Date: | 07/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 028079 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |