Provider Demographics
NPI:1538308226
Name:WONG, NINETTE (DPT)
Entity Type:Individual
Prefix:
First Name:NINETTE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 E NICOLLET BLVD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6741
Mailing Address - Country:US
Mailing Address - Phone:952-892-2650
Mailing Address - Fax:
Practice Address - Street 1:675 E NICOLLET BLVD
Practice Address - Street 2:SUITE 135
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6741
Practice Address - Country:US
Practice Address - Phone:952-892-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist