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NPI Code Detail

MEDICARE: JUDSON A WONG PT

MEDICARE:   JUDSON A WONG  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
1225100000XPhysical Therapist6262WI

Other Identifiers

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

General Provider Information

NPI Number : 1992742290
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDSON A WONG PT
Provider Business Mailing Address
First Line : 202 S PARK ST
Second Line :
City : MADISON
State : WI
Zip : 53715-1507
Country : US
Telephone Number : 608-417-6000
Fax Number :
Provider Business Practice Location Address
First Line : 6408 COPPS AVE
Second Line :
City : MONONA
State : WI
Zip : 53716-3702
Country : US
Telephone Number : 608-417-3131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 12/12/2011

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