Provider Demographics
NPI:1073290961
Name:ONG, GRACE C (RPT-IL)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:C
Last Name:ONG
Suffix:
Gender:F
Credentials:RPT-IL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 N PAULINA ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2307
Mailing Address - Country:US
Mailing Address - Phone:773-729-8215
Mailing Address - Fax:
Practice Address - Street 1:6003 N PAULINA ST UNIT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-2307
Practice Address - Country:US
Practice Address - Phone:773-729-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-008317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist