Provider Demographics
NPI:1215129846
Name:WONG, ALBERT D (PT)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:D
Last Name:WONG
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:1212 GARFIELD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3247
Mailing Address - Country:US
Mailing Address - Phone:304-865-6778
Mailing Address - Fax:304-865-7400
Practice Address - Street 1:47 DEPOT STREET
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-3352
Practice Address - Country:US
Practice Address - Phone:304-865-6778
Practice Address - Fax:304-865-7400
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305005709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist