Individual
STACY WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3004 W FAIDLEY AVE, GRAND ISLAND, NE 68803-4109
(308) 382-0344
Mailing address
3004 W FAIDLEY AVE, GRAND ISLAND, NE 68803-4109
(308) 382-0344
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2894
NE
Other
Enumeration date
07/08/2010
Last updated
02/09/2012
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