Provider Demographics
NPI:1710054911
Name:KWONG, LILLIAN L (MS, PT)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:L
Last Name:KWONG
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:K
Other - Last Name:INOCENTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,PT
Mailing Address - Street 1:1044 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-1401
Mailing Address - Country:US
Mailing Address - Phone:757-752-1907
Mailing Address - Fax:
Practice Address - Street 1:225 CLEARFIELD AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1815
Practice Address - Country:US
Practice Address - Phone:757-452-3599
Practice Address - Fax:757-961-3696
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01414000225100000X
VA2305005436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist