Provider Demographics
NPI:1316434269
Name:LAU, CHUNPONG ALAN (PTA)
Entity type:Individual
Prefix:
First Name:CHUNPONG
Middle Name:ALAN
Last Name:LAU
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25018 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2722
Mailing Address - Country:US
Mailing Address - Phone:281-364-9695
Mailing Address - Fax:
Practice Address - Street 1:25018 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2722
Practice Address - Country:US
Practice Address - Phone:281-364-9695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2083093225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant