Provider Demographics
NPI:1669614004
Name:WONG, CAROLE GOLES (PT)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:GOLES
Last Name:WONG
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 1:410 W POPLAR ST.
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1796
Mailing Address - Country:US
Mailing Address - Phone:509-897-3320
Mailing Address - Fax:509-897-5752
Practice Address - Street 1:410 W POPLAR ST.
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1796
Practice Address - Country:US
Practice Address - Phone:509-897-2100
Practice Address - Fax:509-897-5752
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60060980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist