Provider Demographics
NPI:1295030336
Name:WONG, ALICE Y (D P T)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:Y
Last Name:WONG
Suffix:
Gender:F
Credentials:D P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8638 VETERANS HWY
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1422
Mailing Address - Country:US
Mailing Address - Phone:410-295-8900
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:13 WESTERN MARYLAND PKWY STE 204
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6474
Practice Address - Country:US
Practice Address - Phone:240-452-3205
Practice Address - Fax:301-665-4576
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD206300ZR1SMedicare PIN
DC206271ZRKTMedicare PIN