Provider Demographics
NPI:1134948136
Name:DONG, VINCENT (DPT)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:DONG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39885 GRAND RIVER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2150
Mailing Address - Country:US
Mailing Address - Phone:248-615-0282
Mailing Address - Fax:248-615-0415
Practice Address - Street 1:39885 GRAND RIVER AVE STE 300
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2150
Practice Address - Country:US
Practice Address - Phone:248-615-0282
Practice Address - Fax:248-615-0415
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist