Provider Demographics
NPI:1518325414
Name:SEO, GYEONGCHEOL (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:GYEONGCHEOL
Middle Name:
Last Name:SEO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11011 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1705
Mailing Address - Country:US
Mailing Address - Phone:347-233-3853
Mailing Address - Fax:347-233-4990
Practice Address - Street 1:11011 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11419-1705
Practice Address - Country:US
Practice Address - Phone:347-233-3853
Practice Address - Fax:347-233-4990
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist