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General NPI Number Information
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NPI Number | 1679213607
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Entity Type | Individual
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Provider Name | MICHAEL WONG PT
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Gender | Male
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 2900 PEACHTREE RD NW STE 208
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City | ATLANTA
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State | GA
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Zip | 30305-2189
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Country | US
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Telephone | 678-365-3588
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone | 423-497-0005
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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 | 008558
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | LPT-32127
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP038862T
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License Number State | GA
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