Provider Demographics
NPI:1164276481
Name:WELLNESS PHYSICAL THERAPY & ACUPUNCTURE P.C.
Entity type:Organization
Organization Name:WELLNESS PHYSICAL THERAPY & ACUPUNCTURE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DPT, LAC
Authorized Official - Prefix:
Authorized Official - First Name:SUJEONG
Authorized Official - Middle Name:
Authorized Official - Last Name:GONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, LAC
Authorized Official - Phone:347-827-0009
Mailing Address - Street 1:3821 150TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4927
Mailing Address - Country:US
Mailing Address - Phone:347-827-0009
Mailing Address - Fax:
Practice Address - Street 1:3821 150TH ST FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4927
Practice Address - Country:US
Practice Address - Phone:347-827-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy