Provider Demographics
NPI:1770032781
Name:PAO, DEVIN WANG (PA-C, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:WANG
Last Name:PAO
Suffix:
Gender:F
Credentials:PA-C, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 BRIARGATE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7837
Mailing Address - Country:US
Mailing Address - Phone:719-632-7669
Mailing Address - Fax:
Practice Address - Street 1:4110 BRIARGATE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7837
Practice Address - Country:US
Practice Address - Phone:719-867-7379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00017722255A2300X
COPA.0006977363A00000X
390200000X
CO363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program