Provider Demographics
NPI:1497185482
Name:WONG, SUNNY G (DPT)
Entity Type:Individual
Prefix:DR
First Name:SUNNY
Middle Name:G
Last Name:WONG
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 1:1081 NATHAN DEAN BYP
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-2011
Mailing Address - Country:US
Mailing Address - Phone:678-757-1899
Mailing Address - Fax:
Practice Address - Street 1:1081 NATHAN DEAN BYP
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-2011
Practice Address - Country:US
Practice Address - Phone:678-757-1899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY037325OtherPT LICENSE NUMBER