Basic Information
| Provider Information | |||||||||
| NPI: | 1417420639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARK | ||||||||
| FirstName: | GYUHYUN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 HANSON ST | ||||||||
| Address2: | |||||||||
| City: | WINNEMUCCA | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894453607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756252222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 325 HANSON STEREET | ||||||||
| Address2: | |||||||||
| City: | WINEMUCCA | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894453607 | ||||||||
| CountryCode: | US | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2019 | ||||||||
| LastUpdateDate: | 01/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3910 | NV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3910 | 01 | NV | PHYSICAL THERAPY LICENSE | OTHER |