Provider Demographics
NPI:1437169463
Name:WONG, CAROLANNE L (PT)
Entity Type:Individual
Prefix:
First Name:CAROLANNE
Middle Name:L
Last Name:WONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5091
Mailing Address - Country:US
Mailing Address - Phone:603-225-5132
Mailing Address - Fax:603-225-6061
Practice Address - Street 1:28 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5091
Practice Address - Country:US
Practice Address - Phone:603-225-5132
Practice Address - Fax:603-225-6061
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2154208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
536230OtherCIGNA
NH0805401Y0NH01OtherANTHEM
NH30391168Medicaid
NH30391168Medicaid