Provider Demographics
NPI:1093976714
Name:WANG, DAVIDSON CIACHO (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVIDSON
Middle Name:CIACHO
Last Name:WANG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 POWER ST
Mailing Address - Street 2:
Mailing Address - City:UXBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01569-1339
Mailing Address - Country:US
Mailing Address - Phone:478-318-6178
Mailing Address - Fax:
Practice Address - Street 1:34 ELM ST
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1829
Practice Address - Country:US
Practice Address - Phone:781-383-3815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist