Provider Demographics
NPI:1154769859
Name:CHONG, HICUM ANGELICA (DPT)
Entity type:Individual
Prefix:
First Name:HICUM
Middle Name:ANGELICA
Last Name:CHONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HICUM
Other - Middle Name:ANGELICA
Other - Last Name:CHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 STAINBACK RD
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-3008
Mailing Address - Country:US
Mailing Address - Phone:214-973-8425
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:1600 STAINBACK RD
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-3008
Practice Address - Country:US
Practice Address - Phone:214-973-8425
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1235910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist