Healthcare Provider Details

I. General information

NPI: 1922694124
Provider Name (Legal Business Name): WAYLAND HUANG PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2020
Last Update Date: 12/12/2020
Certification Date: 12/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 SUTTER ST.
SAN FRANCISCO CA
94109
US

IV. Provider business mailing address

1356 34TH AVE
SAN FRANCISCO CA
94122
US

V. Phone/Fax

Practice location:
  • Phone: 415-275-3671
  • Fax:
Mailing address:
  • Phone: 415-335-0838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number299583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: