Individual
MR. BO GONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6559 N WICKHAM RD # C-103, MELBOURNE, FL 32940-2052
(407) 861-6966
Mailing address
2579 OAK ST, KISSIMMEE, FL 34744-4946
(407) 288-4865
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA68483
FL
390200000X
Student in an Organized Health Care Education/Training Program
MA68483
FL
Other
Enumeration date
05/04/2012
Last updated
02/04/2025
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