Provider Demographics
NPI:1467505008
Name:WONG, NATALIE (PT)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:
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 1:3390 MT DIABLO BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4006
Mailing Address - Country:US
Mailing Address - Phone:925-284-6150
Mailing Address - Fax:925-284-6155
Practice Address - Street 1:3390 MT DIABLO BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4006
Practice Address - Country:US
Practice Address - Phone:925-284-6150
Practice Address - Fax:925-284-6155
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056674Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER