Provider Demographics
NPI:1316619539
Name:WONG, KRISTINA (PT, DPT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35367 FARNHAM DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1400
Mailing Address - Country:US
Mailing Address - Phone:510-449-5585
Mailing Address - Fax:
Practice Address - Street 1:3161 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2216
Practice Address - Country:US
Practice Address - Phone:510-796-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT300774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist