Provider Demographics
NPI:1073579140
Name:ONG, CHRISTINE L (PT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:L
Last Name:ONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CRISTINE
Other - Middle Name:L
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1801 FOREST HILLS BLVD
Mailing Address - Street 2:STE.# 205
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-3016
Mailing Address - Country:US
Mailing Address - Phone:479-855-9348
Mailing Address - Fax:479-855-9358
Practice Address - Street 1:1801 FOREST HILLS BLVD
Practice Address - Street 2:STE 205
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-3016
Practice Address - Country:US
Practice Address - Phone:479-855-9348
Practice Address - Fax:479-855-9358
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U946OtherBCBC
AR5U946Medicare ID - Type Unspecified