Provider Demographics
NPI:1407075823
Name:ONG YIU, CHARLES VINCENT A (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES VINCENT
Middle Name:A
Last Name:ONG YIU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053
Mailing Address - Country:US
Mailing Address - Phone:847-470-1844
Mailing Address - Fax:
Practice Address - Street 1:6120 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-3743
Practice Address - Country:US
Practice Address - Phone:708-863-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist