Provider Demographics
NPI:1487833059
Name:WONG, MANTTEE MING YIN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MANTTEE
Middle Name:MING YIN
Last Name:WONG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 E 640 N
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1647
Mailing Address - Country:US
Mailing Address - Phone:801-426-4905
Mailing Address - Fax:
Practice Address - Street 1:797 E 640 N
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1647
Practice Address - Country:US
Practice Address - Phone:801-426-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6657497-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist