Provider Demographics
NPI:1447575444
Name:WANG, PETE (DPT)
Entity Type:Individual
Prefix:DR
First Name:PETE
Middle Name:
Last Name:WANG
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 1:745 PRIMERA BLVD
Mailing Address - Street 2:SUITE 1021
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2186
Mailing Address - Country:US
Mailing Address - Phone:330-283-3008
Mailing Address - Fax:
Practice Address - Street 1:745 PRIMERA BLVD
Practice Address - Street 2:SUITE 1021
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2186
Practice Address - Country:US
Practice Address - Phone:330-283-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist