Individual
ERICA WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1109 CHURCH ST, COLLEYVILLE, TX 76034-5849
(817) 498-3919
(817) 498-7080
Mailing address
1109 CHURCH ST, COLLEYVILLE, TX 76034-5849
(817) 498-3919
(817) 498-7080
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
1357504
TX
225100000X
Physical Therapist
Primary
1357504
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1357504
PT LICENSE
TX
01
—
15508639
CAQH
TX
Enumeration date
02/09/2022
Last updated
12/29/2022
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