Healthcare Provider Details

I. General information

NPI: 1023032299
Provider Name (Legal Business Name): MENG-CHUN WANG PT, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY STE 370
MILWAUKEE WI
53215-3678
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-7900
  • Fax: 414-649-7499
Mailing address:
  • Phone: 414-649-7900
  • Fax: 414-649-7499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License NumberPT007664
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: