Provider Demographics
NPI:1457639288
Name:NG, MICHAEL BRIAN (DPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:NG
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 1:4445 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1221
Mailing Address - Country:US
Mailing Address - Phone:415-661-8176
Mailing Address - Fax:
Practice Address - Street 1:332 PINE ST STE 610
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3228
Practice Address - Country:US
Practice Address - Phone:415-732-5608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist