Provider Demographics
NPI:1952428542
Name:WOON, GORDON WAI LEONG (PT)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:WAI LEONG
Last Name:WOON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 HORTON STREET,
Mailing Address - Street 2:#405
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608
Mailing Address - Country:US
Mailing Address - Phone:510-529-6460
Mailing Address - Fax:
Practice Address - Street 1:2222 BANCROFT WAY
Practice Address - Street 2:#4300
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4303
Practice Address - Country:US
Practice Address - Phone:510-642-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist