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NPI Code Detail

MEDICARE: TERESA M GONG DPT

MEDICARE: TERESA M GONG DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2305216327VA
2225100000XPhysical Therapist036484-1NY

General Provider Information

NPI Number : 1588008833
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA M GONG DPT
Provider Business Mailing Address
First Line : 5309 DISCOVERY PARK BLVD
Second Line :
City : WILLIAMSBURG
State : VA
Zip : 23188-2789
Country : US
Telephone Number : 757-914-6400
Fax Number :
Provider Business Practice Location Address
First Line : 5309 DISCOVERY PARK BLVD
Second Line :
City : WILLIAMSBURG
State : VA
Zip : 23188-2789
Country : US
Telephone Number : 757-914-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2013
Last Update Date : 11/06/2024

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Directions to “ TERESA M GONG DPT” Practice Location

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