Provider Demographics
NPI:1003554080
Name:ONG, MARILYN (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:ONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-2819
Mailing Address - Country:US
Mailing Address - Phone:909-234-6168
Mailing Address - Fax:
Practice Address - Street 1:21 CARMICHAEL ST STE 101
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3186
Practice Address - Country:US
Practice Address - Phone:802-878-9572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN3593OtherMEDICARE
VT1011104Medicaid