Provider Demographics
NPI:1427862754
Name:JEA, MONG TING (PT, DPT)
Entity type:Individual
Prefix:
First Name:MONG TING
Middle Name:
Last Name:JEA
Suffix:
Gender:M
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 1:200 ANDOVER PARK E STE 8
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2938
Mailing Address - Country:US
Mailing Address - Phone:206-575-3136
Mailing Address - Fax:
Practice Address - Street 1:200 ANDOVER PARK E STE 8
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2938
Practice Address - Country:US
Practice Address - Phone:206-575-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61632107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist