Provider Demographics
NPI:1861614869
Name:TONG, SHERRILYN (RPT)
Entity type:Individual
Prefix:
First Name:SHERRILYN
Middle Name:
Last Name:TONG
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:SHERRILYN
Other - Middle Name:TONG
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:1922 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2610
Mailing Address - Country:US
Mailing Address - Phone:714-901-4200
Mailing Address - Fax:714-903-9425
Practice Address - Street 1:1922 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2610
Practice Address - Country:US
Practice Address - Phone:714-901-4200
Practice Address - Fax:714-903-9425
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10360OtherCALIFORNIA PT LICENSE