MEDICARE: HEATHER GAGNON WONG MS PT

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	119884	MO
2	225100000X	Physical Therapist	11-02753	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972577500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER GAGNON WONG MS PT

Provider Business Mailing Address
First Line	:	8340 LINDEN LANE
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66207
Country	:	US
Telephone Number	:	913-707-4303
Fax Number	:

Provider Business Practice Location Address
First Line	:	8340 LINDEN LANE
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66207
Country	:	US
Telephone Number	:	913-707-4303
Fax Number	:

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	01/15/2015

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Directions to “ HEATHER GAGNON WONG MS PT” Practice Location

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