Provider Demographics
NPI:1902496433
Name:TAN, FERDINAND ONG (PT)
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:ONG
Last Name:TAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 HARRIS HAWK WAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76005-1107
Mailing Address - Country:US
Mailing Address - Phone:682-556-1002
Mailing Address - Fax:
Practice Address - Street 1:1223 HARRIS HAWK WAY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76005-1107
Practice Address - Country:US
Practice Address - Phone:682-556-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303110OtherBAYLOR SCOTT AND WHITE