Provider Demographics
NPI:1295085280
Name:ANG, JACQUELINE ONG (PT)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ONG
Last Name:ANG
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 1:52 TOLER LOOP APT 1
Mailing Address - Street 2:
Mailing Address - City:TOLER
Mailing Address - State:KY
Mailing Address - Zip Code:41514
Mailing Address - Country:US
Mailing Address - Phone:606-939-0788
Mailing Address - Fax:
Practice Address - Street 1:52 TOLER LOOP APT 1
Practice Address - Street 2:
Practice Address - City:TOLER
Practice Address - State:KY
Practice Address - Zip Code:41514-8692
Practice Address - Country:US
Practice Address - Phone:606-939-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist