Provider Demographics
NPI:1588906903
Name:TONG, STEPHANIE CY (ATC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CY
Last Name:TONG
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 MARLBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3238
Mailing Address - Country:US
Mailing Address - Phone:301-735-8401
Mailing Address - Fax:
Practice Address - Street 1:6800 MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-3238
Practice Address - Country:US
Practice Address - Phone:301-735-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-24
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260018282255A2300X
MDA00004262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer