Provider Demographics
NPI:1598356263
Name:KO, MYUNGSUNG (DPT)
Entity type:Individual
Prefix:
First Name:MYUNGSUNG
Middle Name:
Last Name:KO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 E NORTH POINTE DR APT 166
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2355
Mailing Address - Country:US
Mailing Address - Phone:657-248-8617
Mailing Address - Fax:
Practice Address - Street 1:404 E FRONT ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-1741
Practice Address - Country:US
Practice Address - Phone:302-280-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist