Healthcare Provider Details

I. General information

NPI: 1215129846
Provider Name (Legal Business Name): ALBERT D WONG PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 DEPOT STREET
CHATHAM VA
24531-3352
US

IV. Provider business mailing address

1212 GARFIELD AVE SUITE 200
PARKERSBURG WV
26101-3247
US

V. Phone/Fax

Practice location:
  • Phone: 304-865-6778
  • Fax: 304-865-7400
Mailing address:
  • Phone: 304-865-6778
  • Fax: 304-865-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305005709
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: