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NPI Code Detail

MEDICARE: RICHARD WONG

MEDICARE: RICHARD 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 Therapist05004267AIN

General Provider Information

NPI Number : 1528275476
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD WONG
Provider Business Mailing Address
First Line : 3324 COBBLEFIELD DR
Second Line :
City : EVANSVILLE
State : IN
Zip : 47711-2282
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2819 N SAINT JOSEPH AVE
Second Line :
City : EVANSVILLE
State : IN
Zip : 47720-1335
Country : US
Telephone Number : 812-424-2941
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2007
Last Update Date : 07/08/2007

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Directions to “ RICHARD WONG ” Practice Location

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