Provider Demographics
NPI:1548981632
Name:YANG, TAERYEON (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:DR
First Name:TAERYEON
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4199 MAIN ST STE 202B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5164
Mailing Address - Country:US
Mailing Address - Phone:929-600-4257
Mailing Address - Fax:833-985-0130
Practice Address - Street 1:4199 MAIN ST STE 202B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5164
Practice Address - Country:US
Practice Address - Phone:929-600-4257
Practice Address - Fax:833-985-0130
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty