# DR. NICHOLAS ROBERT MONG

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1265767834
- **Gender:** Man
- **Credential:** P.T., D.P.T., A.T.C.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 05888 | OR | Yes |
| 2255A2300X | Athletic Trainer | RT004181 | PA | — |

## Other

- **Enumeration date:** 10/15/2009
- **Last updated:** 02/20/2010