Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT13997 | CA |
N | 2251S0007X | Physical Therapist - Sports | PT13997 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT13997 | CA |
NPI | 1144423302 |
---|---|
Provider Name | Barry Harvey Wong |
First Address | Orange, CA 92867-4061 |
Second Address | Orange, CA 92867-4061 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 28/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT13997 | PT LICENSE# (01) | CA |