MEDICARE: ANGIE WONG LMT

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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1376222935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGIE WONG LMT

Provider Business Mailing Address
First Line	:	11036 MOORPARK ST APT 422
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91602-3445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 W SUNSET BLVD # B200-22
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-2439
Country	:	US
Telephone Number	:	909-576-3888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2023
Last Update Date	:	10/29/2023

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Directions to “ ANGIE WONG LMT” Practice Location

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