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General NPI Number Information
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NPI Number | 1972577500
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Entity Type | Individual
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Provider Name | HEATHER GAGNON WONG MS PT
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Gender | Female
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 8340 LINDEN LANE
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66207
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Country | US
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Telephone | 913-707-4303
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Fax |
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Provider Business Mailing Address
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Address Line | 8340 LINDEN LANE
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66207
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Country | US
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Telephone | 913-707-4303
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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 | 119884
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11-02753
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License Number State | KS
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