Organization
PHYSICAL REHAB ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN M WONG MD (OWNER)
(804) 424-0896
Entity
Organization
Contact information
Practice address
11357 NUCKOLS RD STE 2118, GLEN ALLEN, VA 23059-5504
(804) 424-0896
Mailing address
PO BOX 872, AGOURA HILLS, CA 91376-0872
(818) 518-7226
(818) 671-2225
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101262431
MEDICAL LICENSE
VA
Enumeration date
01/24/2023
Last updated
01/24/2023
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