Provider Demographics
NPI:1659491322
Name:WONG, REBECCA CHI-LAN (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CHI-LAN
Last Name:WONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 LOS GATOS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2028
Mailing Address - Country:US
Mailing Address - Phone:408-358-1460
Mailing Address - Fax:
Practice Address - Street 1:15100 LOS GATOS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2028
Practice Address - Country:US
Practice Address - Phone:408-358-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335652251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics