Provider Demographics
NPI:1902981186
Name:INGLEWOOD PHYSICAL THERAPY PS
Entity Type:Organization
Organization Name:INGLEWOOD PHYSICAL THERAPY PS
Other - Org Name:CHRISTOPHER YB WONG OWNER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:YB
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:425-821-3775
Mailing Address - Street 1:14050 JUANITA DR NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-821-3775
Mailing Address - Fax:425-821-1986
Practice Address - Street 1:14050 JUANITA DR NE
Practice Address - Street 2:SUITE B
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-821-3775
Practice Address - Fax:425-821-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7101744Medicaid
WA8851073Medicare ID - Type Unspecified
191643Medicare ID - Type UnspecifiedL & I
WA7101744Medicaid