Provider Demographics
NPI:1306366265
Name:CHUNG, TONY (DPT)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 4108
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4541
Mailing Address - Country:US
Mailing Address - Phone:470-238-3683
Mailing Address - Fax:470-238-3816
Practice Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 4108
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4541
Practice Address - Country:US
Practice Address - Phone:470-238-3683
Practice Address - Fax:470-238-3816
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist