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NPI Code Detail

MEDICARE: MARLON WONG

MEDICARE: MARLON WONG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT20573OTHERFLLICENSE #

General Provider Information

NPI Number : 1043320955
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARLON WONG
Provider Business Mailing Address
First Line : 11115 SW 168TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33157-4009
Country : US
Telephone Number : 305-253-4770
Fax Number :
Provider Business Practice Location Address
First Line : 4016 CHASE AVE
Second Line :
City : MIAMI BEACH
State : FL
Zip : 33140-3421
Country : US
Telephone Number : 305-538-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/08/2007

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