Provider Demographics
NPI:1063703874
Name:ONG, MICHAEL CAEZAR CAMACHO (RPT)
Entity type:Individual
Prefix:
First Name:MICHAEL CAEZAR
Middle Name:CAMACHO
Last Name:ONG
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3201 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3440
Mailing Address - Country:US
Mailing Address - Phone:954-332-4450
Mailing Address - Fax:800-856-4778
Practice Address - Street 1:3201 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3440
Practice Address - Country:US
Practice Address - Phone:954-332-4450
Practice Address - Fax:800-856-4778
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist