Provider Demographics
NPI:1639920143
Name:WANG, ROCKY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ROCKY
Middle Name:
Last Name:WANG
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 1:33995 FREDERICK LN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2526
Mailing Address - Country:US
Mailing Address - Phone:510-516-8994
Mailing Address - Fax:
Practice Address - Street 1:5600 MOWRY SCHOOL RD STE 305
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5371
Practice Address - Country:US
Practice Address - Phone:510-651-9258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist