Individual
AMY FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1970 LAKE BLVD STE 4, DAVIS, CA 95616-5663
(530) 753-9355
Mailing address
102 W GIBSON RD, WOODLAND, CA 95695-4560
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
30188
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689606469
PHYSICAL EDGE, INC.
CA
01
—
1770675639
PHYSICAL EDGE, INC.
CA
Enumeration date
10/14/2006
Last updated
01/03/2022
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