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General NPI Number Information
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NPI Number | 1255830071
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Entity Type | Organization
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Legal Business Name | EUNICE GONG, PT, LLC
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 01/20/2019
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Provider Practice Location Address
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Address Line | 9 LAKE BELLEVUE DR STE 216
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City | BELLEVUE
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State | WA
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Zip | 98005
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Country | US
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Telephone | 425-610-8194
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Fax | 425-610-6960
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Provider Business Mailing Address
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Address Line | 7930 SE 34TH ST APT 207
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City | MERCER ISLAND
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State | WA
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Zip | 98040-3556
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Country | US
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Telephone | 425-610-8194
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Fax | 425-610-6960
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Authorized Official
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Title or Position | MEMBER
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Name | EUNICE GONG
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Credential | PT
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Telephone | 425-610-8194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00008072
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License Number State | WA
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