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General NPI Number Information
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NPI Number | 1295085280
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Entity Type | Individual
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Provider Name | JACQUELINE ONG ANG PT
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Gender | Female
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 52 TOLER LOOP APT 1
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City | TOLER
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State | KY
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Zip | 41514-8692
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Country | US
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Telephone | 606-939-0788
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Fax |
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Provider Business Mailing Address
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Address Line | 52 TOLER LOOP APT 1
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City | TOLER
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State | KY
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Zip | 41514
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Country | US
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Telephone | 606-939-0788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 004944
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License Number State | KY
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