Provider Demographics
NPI:1073685103
Name:WONG, CHRISTOPHER YB (MPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:YB
Last Name:WONG
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 JUANITA DR. N.E.
Mailing Address - Street 2:SUITE B
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-821-3775
Mailing Address - Fax:425-821-1986
Practice Address - Street 1:14050 JUANITA DR. N.E.
Practice Address - Street 2:SUITE B
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-821-3775
Practice Address - Fax:425-821-1986
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
137931OtherINDIVID L & I
6489W0OtherINDIVID REGENCE
WA7101744Medicaid
8851320Medicare ID - Type Unspecified
6489W0OtherINDIVID REGENCE