Provider Demographics
NPI:1255830071
Name:EUNICE GONG, PT, LLC
Entity Type:Organization
Organization Name:EUNICE GONG, PT, LLC
Other - Org Name:INBALANCE PT AND BOWENWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-610-8194
Mailing Address - Street 1:7930 SE 34TH ST APT 207
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3556
Mailing Address - Country:US
Mailing Address - Phone:425-610-8194
Mailing Address - Fax:425-610-6960
Practice Address - Street 1:9 LAKE BELLEVUE DR STE 216
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-610-8194
Practice Address - Fax:425-610-6960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty