Provider Demographics
NPI:1073833349
Name:WANG, ELEANOR K (PT)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:K
Last Name:WANG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1001 CROMWELL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3300
Mailing Address - Country:US
Mailing Address - Phone:410-823-0880
Mailing Address - Fax:410-823-7905
Practice Address - Street 1:1001 CROMWELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3300
Practice Address - Country:US
Practice Address - Phone:410-823-0880
Practice Address - Fax:410-823-7905
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD14365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist