Provider Demographics
NPI:1164766762
Name:ONG, MARCHILLES YU (RPT)
Entity Type:Individual
Prefix:
First Name:MARCHILLES
Middle Name:YU
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 1:1402 HIGHGATE RD
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-3843
Mailing Address - Country:US
Mailing Address - Phone:240-344-5851
Mailing Address - Fax:
Practice Address - Street 1:509 S I ST
Practice Address - Street 2:SUITE A
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4660
Practice Address - Country:US
Practice Address - Phone:559-673-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034671-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist