Individual
MECLENA ABIGAIL WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1220 S ELISEO DR, GREENBRAE, CA 94904-2006
(415) 461-9700
Mailing address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
09740
OR
225200000X
Physical Therapy Assistant
Primary
50540
CA
Other
Enumeration date
05/19/2019
Last updated
05/19/2021
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