Provider Demographics
NPI:1376375428
Name:WONG, JEREMY (PT, DPT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 ANCHOR POINT CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1614
Mailing Address - Country:US
Mailing Address - Phone:832-375-4762
Mailing Address - Fax:
Practice Address - Street 1:4899 HIGHWAY 6 STE C&213C
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3987
Practice Address - Country:US
Practice Address - Phone:346-371-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1398917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist