Provider Demographics
NPI:1861634511
Name:WONG, REBECCA (DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2779
Mailing Address - Country:US
Mailing Address - Phone:480-641-3533
Mailing Address - Fax:480-641-3935
Practice Address - Street 1:5440 E SOUTHERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2779
Practice Address - Country:US
Practice Address - Phone:480-641-3533
Practice Address - Fax:480-641-3935
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist