Provider Demographics
NPI:1083395982
Name:WONG, ANDY (PT, DPT, MBA)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:PT, DPT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 CENTRAL ST APT C9
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-1376
Mailing Address - Country:US
Mailing Address - Phone:508-397-2539
Mailing Address - Fax:
Practice Address - Street 1:136 CENTRAL ST APT C9
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-1376
Practice Address - Country:US
Practice Address - Phone:508-397-2539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
25044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist