Provider Demographics
NPI:1003487794
Name:CHARLES WANG PHYSICAL THERAPIST PC
Entity Type:Organization
Organization Name:CHARLES WANG PHYSICAL THERAPIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, CEO, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:714-878-3651
Mailing Address - Street 1:176 TERRAPIN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0854
Mailing Address - Country:US
Mailing Address - Phone:714-878-3651
Mailing Address - Fax:
Practice Address - Street 1:176 TERRAPIN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0854
Practice Address - Country:US
Practice Address - Phone:714-878-3651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy