Provider Demographics
NPI:1558729707
Name:DU AY, GIOVANNI COLEONGCO (RPT)
Entity Type:Individual
Prefix:MR
First Name:GIOVANNI
Middle Name:COLEONGCO
Last Name:DU AY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 HIGHLAND AVE SW
Mailing Address - Street 2:APT. 203
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4321
Mailing Address - Country:US
Mailing Address - Phone:540-492-1584
Mailing Address - Fax:
Practice Address - Street 1:1615 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-5208
Practice Address - Country:US
Practice Address - Phone:540-224-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207072225100000X
TX1196790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist