Provider Demographics
NPI:1104253590
Name:FONG, PATRICIA KATHERINE (DPT)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:KATHERINE
Last Name:FONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 CREEKSIDE DR
Mailing Address - Street 2:3063
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5669
Mailing Address - Country:US
Mailing Address - Phone:916-204-9184
Mailing Address - Fax:
Practice Address - Street 1:1441 CREEKSIDE DR
Practice Address - Street 2:3063
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5669
Practice Address - Country:US
Practice Address - Phone:916-204-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist