Provider Demographics
NPI:1750948923
Name:WANG, ALDRICH TIO (DPT, PT)
Entity type:Individual
Prefix:
First Name:ALDRICH
Middle Name:TIO
Last Name:WANG
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 LOS RIOS BLVD STE 132
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3478
Mailing Address - Country:US
Mailing Address - Phone:972-509-5070
Mailing Address - Fax:972-509-1557
Practice Address - Street 1:2200 LOS RIOS BLVD STE 132
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-3478
Practice Address - Country:US
Practice Address - Phone:972-509-5070
Practice Address - Fax:972-509-1557
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
TX1389598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer