Provider Demographics
NPI:1144590431
Name:ONG, JULIUS PUA (RPT)
Entity Type:Individual
Prefix:MR
First Name:JULIUS
Middle Name:PUA
Last Name:ONG
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N. SEAFURY LANE
Mailing Address - Street 2:APT 202
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9423
Mailing Address - Country:US
Mailing Address - Phone:208-559-8462
Mailing Address - Fax:
Practice Address - Street 1:212 N SEA FURY LN
Practice Address - Street 2:APT 202
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9421
Practice Address - Country:US
Practice Address - Phone:208-559-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist